title: Buried or unburied K-wires for lateral condyle elbow fractures.
abstract: BACKGROUND
  Lateral humeral condyle fractures typically require a longer period of internal fixation than other distal humeral fractures due to the increased risk of non-union. K-wires can be buried and left in situ until union or they can be left unburied and require removal after  four weeks, with plaster immobilisation until union. There is no consensus as to whether wire burial is preferable or not. The aim of this study was to determine whether K-wire burial is associated with more complications than non-buried wires in treating lateral condyle fractures of the elbow.
  
  
  METHODS
  All patients with lateral humeral condyle fractures treated with K-wire fixation at our institution from May 2008 to August 2011 were included in the study. Fracture configuration, mode of reduction, wire burial and complications were assessed.
  
  
  RESULTS
  Sixty-seven patients (19  girls and 48 boys, mean age: 6.5 years, range: 1-17 years) were included in the study. All had closed injuries and were treated with open reduction and K-wire fixation. K-wires were buried in 55 patients. Thirteen cases of buried wires eroded through skin and were removed on average  45 days (range: 30-58 days) post-operatively. Of the wire erosion cases, three developed microbiologically proven infections, one of which was a deep infection. There were a further three superficial wound infections in the absence of wire erosion through the skin. There were complications  in 2 of the 12 cases in the unburied wires group: 1 microbiologically proven superficial wire site infection and 1 wire backed out after 11 days, requiring refixation.
  
  
  CONCLUSIONS
  Wire erosion through the skin is the most common complication of K-wire burial. This may be due to the decrease  in swelling after fracture fixation, making the wires more prominent under the skin. Skin integrity should be monitored closely if wires are buried.
authors.affiliation: Alder Hey Children's NHS Foundation Trust, UK. lorcanmcgonagle@hotmail.com
authors.forename: L
authors.initials: L
authors.lastname: McGonagle
authors.forename: S
authors.initials: S
authors.lastname: Elamin
authors.forename: D M
authors.initials: DM
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D007223:Infant; D008297:Male; D016896:Treatment Outcome