Abstract: Anatomic reduction of all displaced pediatric supracondylar humerus fractures is not possible via closed manipulation, thus necessitating open reduction. Open reduction has been associated with increased complications, including elbow stiffness, scarring, iatrogenic neurovascular injury, and longer hospital stays. We used a 3mm k-wire to aid in closed reduction thus decreasing the need for conversion to an open procedure, possibly reducing morbidity.
Description of Technique: A percutaneously placed 3-mm k-wire was drilled into the posterior humeral diaphysis and used as a joystick to reduce anterior and posterior, varus and valgus, and rotational deformity. The fracture then was stabilized with1.5/ 2-mm K-wires placed under fluoroscopy and the 3mm k-wire was then removed.
Methods: We reviewed all displaced pediatric supracondylar humerus fractures treated at IMS&SUM Hospital, Bhubaneswar from October 2016 through August 2018.We included 60 fractures meeting criteria for inclusion. These fractures then were divided into two groups. Group A (30 fractures) included fractures treated without implantation of the 3mm K-wire. In this group, if successful reduction could not be achieved via closed manipulations, a formal open reduction was performed. In Group B, (30 fractures) the thick k-wire technique was used to assist with reduction of fractures. All fractures were stabilized with the 1.5/ 2-mm K-wires after the reductions. Injury data, operative technique, complications, and radiographic reduction were analyzed. The minimum followup for both groups was 8 weeks (average 12 weeks; range, 8–40 weeks) to monitor clinical and radiological recovery. Range of motion and loss of carrying angle was assessed according to Flynn's criteria (Table. 8, 9).
Results: No fractures in Group B (zero of 30, 0%) compared with Group A (three of 30, 10%) required open reduction. As regards fracture alignment at final followup and postoperative complications, Group B patients had superior results compared to group A.
Conclusions: A posteriorly placed 3mm k-wire aids in anatomic reduction and decreases the need for open treatment of displaced pediatric supracondylar humerus fractures, without compromising the complication rate or final radiographic outcome
