title: Intraoperative stability testing of lateral-entry pin fixation of pediatric supracondylar humeral fractures.
abstract: The aims of this study were (1) to ascertain prospectively whether rotational instability can be determined intraoperatively and (2) to quantify the incidence of rotational instability after lateral-entry wire fixation in type-3 supracondylar humeral fractures in children according to Wilkins modification of Gartland classification. (Fractures in Children. Vol 3. 4th ed. 1996:669-750). Twenty-one consecutive patients admitted with type-3 supracondylar fractures at the Children's Hospital at Westmead were surgically treated according to a predetermined protocol. After closed fracture reduction, 2 lateral-entry wires were inserted under radiographic control. Stability was then assessed by comparing lateral fluoroscopic images in internal and external rotation. If the fracture remained rotationally unstable, a third lateral-entry wire was inserted, and images were repeated. A medial wire was used only if instability was demonstrated after the insertion of 3 lateral wires. Rotational stability was achieved with 2 lateral-entry wires in 6 cases, 3 lateral-entry wires in 10 cases, and with an additional medial wire in 5 cases. Our results were compared with a control group of patients treated at our hospital before the introduction of this protocol. No patients required a reoperation after the introduction of our protocol as opposed to 6 patients in the control group. On analysis of radiographs, the protocol resulted in significantly less fracture position loss as evidenced by change in Baumann angle (P < 0.05) and lateral rotational percentage (P < 0.05). We conclude that supracondylar fractures that are rotationally stable intraoperatively after wire fixation are unlikely to displace postoperatively. Only a small proportion (26%) of these fractures were rotationally stable with 2 lateral-entry wires.
authors: Children's Hospital at Westmead, Sydney, Australia. m_zenios@hotmail.com
authors: Michalis
authors: M
authors: Zenios
authors: Manoj
authors: M
authors: Ramachandran
authors: Ben
authors: B
authors: Milne
authors: David
authors: D
authors: Little
authors: Nicholas
authors: N
authors: Smith
mesh_terms: D001858:Bone Nails; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D005260:Female; D005471:Fluoroscopy; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D012399:Rotation; D016896:Treatment Outcome