scholarly journals Lateral condyle elbow fractures: Buried versus unburied K-wires

2013 ◽  
Vol 11 (8) ◽  
pp. 711
Author(s):  
Salma E. Elamin ◽  
Lorcan McGonagle ◽  
David Wright
Keyword(s):  
Lateral Condyle ◽  
Elbow Fractures ◽  
K Wires

scholarly journals Cannulated screw versus Kirschner-wire fixation for Milch II lateral condyle fractures in a paediatric sawbone model: a biomechanical comparison

2018 ◽  
Vol 12 (1) ◽  
pp. 29-35 ◽  
Author(s):  
D. Franks ◽  
J. Shatrov ◽  
M. Symes ◽  
D. G. Little ◽  
T. L. Cheng
Keyword(s):  
Screw Fixation ◽  
Cannulated Screw ◽  
Screw Placement ◽  
Lateral Condyle ◽  
Rigid Fixation ◽  
Cannulated Screws ◽  
Lateral Column ◽  
Elbow Fractures ◽  
Wire Fixation ◽  
K Wires

Purpose Lateral condyle fractures of the humerus are common in the paediatric population, accounting for up to 20% of elbow fractures. Traditional management involves internal fixation with Kirschner (K)-wires, however, this has been associated with complications and insufficiently rigid fixation. Recently, cannulated screws have been proposed as a more stable method of fixation. While cannulated screws have been thought to allow earlier range of movement and shorten time to union, data regarding the biomechanical performance and optimal screw placement is scarce. We hypothesize that cannulated screw fixation is superior to K-wire fixation and screw placement can enhance the stability of the construct. Methods Paediatric humerus sawbones with Milch II fractures were fixed with one of three methods. Fractures were reduced with either a single cannulated screw either through the centre of the capitellum (oblique), or placed up the lateral column across the growth plate (lateral), or fixed with two K-wires. Fixed sawbone fractures were then mechanically tested in two directions simulating in vivo forces. Results The lateral screw construct had a higher maximum force to failure, higher stiffness and absorbed higher energy as compared with the K-wire fixation and oblique screw under an anterior force. When loaded from the posterior direction, only the lateral column screw was better than K-wire fixation. Conclusions Screw fixation is a biomechanically effective alternative to K-wire fixation, especially when placed up the lateral column of the distal humerus. Further clinical studies are required before transcapitellar screw fixation can be adopted.

scholarly journals Buried or unburied K-wires for lateral condyle elbow fractures

2012 ◽  
Vol 94 (7) ◽  
pp. 513-516 ◽  
Author(s):  
L McGonagle ◽  
S Elamin ◽  
DM Wright
Keyword(s):  
Deep Infection ◽  
Lateral Condyle ◽  
Non Union ◽  
Increased Risk ◽  
Elbow Fractures ◽  
Wire Fixation ◽  
Superficial Wound ◽  
Fracture Configuration ◽  
K Wires ◽  
Humeral Condyle

INTRODUCTION 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.

Open reduction of pediatric lateral condyle fractures: a systematic review

2021 ◽  
pp. 175857322110102
Author(s):  
Michael D Eckhoff ◽  
Josh C Tadlock ◽  
Tyler C Nicholson ◽  
Matthew E Wells ◽  
EStephan J Garcia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Internal Fixation ◽  
Range Of Motion ◽  
Lateral Condyle ◽  
Elbow Fracture ◽  
Infection Rates ◽  
Fixation Techniques ◽  
K Wires ◽  
Pediatric Elbow Fracture ◽  
The Cost

Introduction Lateral condyle fractures are the second most common pediatric elbow fracture. There exist multiple options for internal fixation including buried K-wires, unburied K-wires, and screw fixation. Our study aims to review the current literature and determine if fixation strategy affects outcomes to include fracture union, postoperative range of motion, and need subsequent surgery. Methods A systematic review of Pubmed, MEDLINE, and EMBASE databases was performed. Included articles involve pediatric patients with displaced lateral condyle fractures treated with internal fixation that reported outcomes to include union rates and complications. Results Thirteen studies met inclusion criteria for a total of 1299 patients (472 buried K-wires, 717 unburied K-wires, and 110 screws). The patients’ average age was 5.8 ± 0.6 years, male (64%), and had 16.3 months of follow-up. No differences in union and infection rates were found. Unburied K-wires had the shortest time to union and the greatest elbow range of motion postoperatively. Conclusions Our systematic review demonstrates similar outcomes with union and infection rates between all fixation techniques. Unburied K-wires demonstrated a shorter time to union and the greatest postoperative range of motion. Additionally, unburied K-wires may be removed in clinic, decreasing the cost on the healthcare system. Evidence Level 3.

scholarly journals Epidemiology of paediatric elbow fractures: a retrospective multi-centre study of 488 fractures

2019 ◽  
Vol 13 (5) ◽  
pp. 516-521 ◽  
Author(s):  
H. Okubo ◽  
M. Nakasone ◽  
M. Kinjo ◽  
K. Onaka ◽  
C. Futenma ◽  
...  
Keyword(s):  
Case Series ◽  
Fracture Rate ◽  
Lateral Condyle ◽  
Supracondylar Fractures ◽  
Level Of Evidence ◽  
Multi Centre Study ◽  
Fractures In Children ◽  
Elbow Fractures ◽  
Operation Rate ◽  
Age Range

Purpose Elbow fractures are common in children and occur during daily activities. The aim of this study is to evaluate the epidemiology of paediatric elbow fractures over a two-year period in Okinawa, a southern subtropical island in Japan. Methods This was a retrospective study of 488 elbow fractures in children younger than 15 years old treated at 11 hospitals in Okinawa. Data included age, gender, calendar month, type of fracture, operation rate, mechanism of injury, and aetiology. Results The most frequent age was 6 years old, with 47.5% of all elbow fractures occurring in an age range from 6 to 10 years old. The fracture rate for boys was 1.6 times higher than that for girls. The incidence was the highest in May (56 fractures) and the lowest in August (25 fractures). Supracondylar fractures were the most common type (44%), followed by lateral condyle fractures (22%); 45% of all fractures were treated operatively. Medial epicondyle fractures had the highest rate of operative treatment (91%). In the 6 to 10-year-old group, 19% of all fractures occurred while skateboarding or caster-boarding, the most frequent aetiology. Conclusions Supracondylar fractures are the most common fracture type in 4 to 7-year-old boys. In the 6 to 10-year-old group, skateboarding and caster-boarding are the most frequent and increasing cause of elbow fractures. Therefore, some preventive measures are needed. Level of evidence Level IV, case series

Lateral condylar fractures of the humerus in children

2018 ◽  
Vol 100-B (3) ◽  
pp. 387-395 ◽  
Author(s):  
R. Ganeshalingam ◽  
A. Donnan ◽  
O. Evans ◽  
M. Hoq ◽  
M. Camp ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Screw Fixation ◽  
Kirschner Wire ◽  
Lateral Condyle ◽  
Fractures In Children ◽  
Wire Fixation ◽  
Long Term Follow Up ◽  
Carrying Angle ◽  
K Wires ◽  
Condylar Fractures

Aims Displaced fractures of the lateral condyle of the humerus are frequently managed surgically with the aim of avoiding nonunion, malunion, disturbances of growth and later arthritis. The ideal method of fixation is however not known, and treatment varies between surgeons and hospitals. The aim of this study was to compare the outcome of two well-established forms of surgical treatment, Kirschner wire (K-wire) and screw fixation. Patients and Methods A retrospective cohort study of children who underwent surgical treatment for a fracture of the lateral condyle of the humerus between January 2005 and December 2014 at two centres was undertaken. Pre, intraoperative and postoperative characteristics were evaluated. A total of 336 children were included in the study. Their mean age at the time of injury was 5.8 years (0 to 15) with a male:female patient ratio of 3:2. A total of 243 (72%) had a Milch II fracture and the fracture was displaced by > 2 mm in 228 (68%). In all, 235 patients underwent K-wire fixation and 101 had screw fixation. Results There was a higher rate of nonunion with K-wire fixation (p = 0.02). There was no difference in Baumann’s angle, carrying angle or the rate of major complications between the two groups. No benefit was obtained by immobilizing the elbow for more than four weeks in either group. No short-term complications were seen when fixation crossed the lateral ossific nucleus. Conclusions Fixation of lateral condylar humeral fractures in children using either K-wires or screws gives satisfactory results. Proponents of both techniques may find justification of their methods in our data, but prospective, randomized trials with long-term follow-up are required to confirm the findings, which suggest a higher rate of nonunion with K-wire fixation. Cite this article: Bone Joint J 2018;100-B:387–95.

Buried versus unburied Kirschner wires in the management of paediatric lateral condyle elbow fractures

2016 ◽  
Vol 25 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Neal M. Ormsby ◽  
Roger D.M. Walton ◽  
Simon Robinson ◽  
Stephen Brookes-Fazakerly ◽  
Fernando Yuen Chang ◽  
...  
Keyword(s):  
Lateral Condyle ◽  
Kirschner Wires ◽  
Elbow Fractures

scholarly journals Paediatric lateral humeral condyle fractures managed by k-wire fixation, should the wires be buried or left exposed: a dilemma

2020 ◽  
Vol 7 (1) ◽  
pp. 78
Author(s):  
Nitin Choudhary ◽  
Sanjeev Gupta ◽  
Neeraj Mahajan ◽  
Rahul Mahajan ◽  
Amar Saharan
Keyword(s):  
Exposed Group ◽  
Lateral Condyle ◽  
Risk Of Infection ◽  
Union Rate ◽  
Kirschner Wires ◽  
Major Procedure ◽  
Carrying Angle ◽  
K Wires ◽  
A Prospective Study ◽  
Humeral Condyle

<p><strong>Background:</strong> Fractures of the lateral condyle of the humerus in children are common injuries. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). These may be passed through the skin and left exposed or buried subcutaneously.</p><p><strong>Methods:</strong> A prospective study was carried out in department of orthopaedics at my college from January 2019 to March 2020.  A total number of 37 subjects were included in the study.</p><p><strong>Results:</strong> Patients were followed for a period of 3 months and results were drawn on basis of union, infection, carrying angle at the elbow, and range of motion (ROM) which was assessed by clinico-radiological means.</p><p><strong>Conclusions: </strong>Buried wire group has shown better union rate than exposed group, wires could be removed under local anaesthesia thereby avoiding any major procedure and also the risk of infection is low making this a better option than the exposed cohort.</p>

scholarly journals Open reduction and K-wires fixation of medial humeral epicondyle fractures with intra-articular elbow entrapment in children

2020 ◽  
Vol 8 (1) ◽  
pp. 73-82
Author(s):  
Daniele Massetti ◽  
Mario Marinelli ◽  
Valentino Coppa ◽  
Danya Falcioni ◽  
Nicola Specchia ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Upper Limb ◽  
Open Reduction ◽  
Medial Epicondyle ◽  
Oral Antibiotic ◽  
Radiographic Outcomes ◽  
Elbow Fractures ◽  
Wire Fixation ◽  
The Mean ◽  
K Wires

Background. Medial epicondyle fracture (MEF) is a common injury of all elbow fractures in the pediatric and adolescent population and is often associated with elbow dislocation. Traditional management by cast immobilization increasingly is being replaced with early open reduction and K-wires or screws fixation. A consensus about the correct treatment of MEF is currently lacking in the medical literature. The aim of this study was to report the clinical and radiographic outcomes and the complications of patients affected from MEF with intra-articular fragment incarceration treated by open reduction and K-wire fixation. Materials and methods. Thirteen children (aged 813 years) with medial epicondyle fractures (MEF) with intra-articular elbow entrapment were retrospectively reviewed. All the enrolled patients were surgically treated with open reduction and k-wire fixation without exploration of ulnar nerve. Clinical outcomes were evaluated using upper limb alignment in the frontal plane, elbow range of motion (ROM), the Mayo Elbow Performance Score (MEPS) and with the Visual Analogue Scale (VAS). Radiographic outcomes and complications were also evaluated. Results. At a mean follow-up of 24.1 months no patients showed axial deformity of the upper limb or instability of the elbow and with preserved elbow ROM. The mean MEPS was 98.8 and the mean value of the VAS score was 1. The final X-rays showed fracture healing in 11 patients while 2 (15.3%) reported asymptomatic nonunion. Six patients of 13 presented with preoperative paresthesia in the ulnar nerve field but all of them reported a complete recovery after a mean of 4.3 months. All patients returned to their sporting activities at a mean of 5.4 months after surgery. One patient (7.7%) reported a superficial surgical wound infection treated with oral antibiotic medication without further surgery. No other complication was found. Conclusions. The results demonstrate that open reduction and K-wires fixation without exploration of ulnar nerve for MEF with intra-articular elbow entrapment treatment is a safe and effective procedure.

scholarly journals ABCD of Lateral Condyle Humerus Fracture in Children: Anatomy, Biomechanics, Classification and Diagnosis

2021 ◽  
Vol 7 (2) ◽  
Keyword(s):  
Decision Making ◽  
Internal Rotation ◽  
Delayed Diagnosis ◽  
Signs And Symptoms ◽  
Classification Systems ◽  
Lateral Condyle ◽  
X Ray ◽  
Lateral Condyle Fracture ◽  
Elbow Fractures ◽  
Condyle Fracture

The lateral condyle fractures which form less than 20% of paediatric elbow fractures are seen at average 6 years age and have less severity of signs and symptoms which may lead to delayed diagnosis. Internal rotation view of X-ray of elbow is important in addition to standard AP and Lateral views. Jakob, Weiss and Song are commonly used classification systems in decision making. Keywords: Lateral condyle fracture, Children, Classification, Anatomy, Diagnosis.

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