Intramedullary Kirschner Wire Fixation of Open or Unstable Forearm Fractures in Children

Background: Distal humeral fractures are one of the most common types of fractures in children, most of them being supracondylar. Supracondylar fractures are usually caused by trauma, most likely falls. It is an emergency, requiring rapid diagnosis and management to avoid serious complications. Recommended treatment modalities vary from no reduction and immobilization to open reduction and internal fixation. Kirschner wire (K-wire) fixation of displaced supracondylar fractures after closed reduction is a preferred method and is being performed for over 50 years now. This study was conducted to determine the functional outcome of crossed K-wire fixation in pediatric supracondylar fracture.Methods: This prospective study was conducted from May-November 2018 at the department of Orthopedics, Abbasi Shaheed Hospital, Karachi, Pakistan. It was inferred that functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation. It included 83 children with supracondylar fractures. They were treated with percutaneous crossed K-wire fixation. Patients were then followed up to determine satisfactory functional outcome according to Flynn’s criteria. Data entry and analysis was done using SPSS 21.0.Results: Eight-three patients were included. The mean±standard deviation age of this study population was 7.03±3.39 years. Out of the study participants, 47 (56.6%) were males and 36 (43.4%) were females. 71.1% of the patients were of Gartland class II fractures and 28.9% were of Gartland class III. 43.4% had an injury due to fall while playing while 19.3% had fallen from height. 80.7% were found to have a satisfactory functional outcome.Conclusions: It was inferred that the functional outcome of pediatric displaced supracondylar humeral fractures is satisfactory when managed with percutaneous crossed K-wire fixation.

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Biomechanical comparison of flexible intramedullary nailing versus crossed Kirschner wire fixation in a canine model of pediatric forearm fractures

Journal of Pediatric Orthopaedics B ◽

10.1097/01202412-200609000-00012 ◽

2006 ◽

Vol 15 (5) ◽

pp. 370-375 ◽

Cited By ~ 8

Author(s):

Jacob Battle ◽

Kelly D. Carmichael ◽

Randal P. Morris

Keyword(s):

Intramedullary Nailing ◽

Kirschner Wire ◽

Canine Model ◽

Forearm Fractures ◽

Flexible Intramedullary Nailing ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Biomechanical Comparison

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Unstable Diametaphyseal Forearm Fractures: Transepiphyseal Intramedullary Kirschner-Wire Fixation as a Treatment Option in Children

European Journal of Pediatric Surgery ◽

10.1055/s-0030-1262843 ◽

2010 ◽

Vol 20 (06) ◽

pp. 395-398 ◽

Cited By ~ 13

Author(s):

J. Lieber ◽

E. Schmid ◽

P. Schmittenbecher

Keyword(s):

Treatment Option ◽

Kirschner Wire ◽

Forearm Fractures ◽

Kirschner Wire Fixation ◽

Wire Fixation

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UNSTABLE FRACTURE OF RADIUS AND ULNA

The Professional Medical Journal ◽

10.29309/tpmj/2011.18.02.2102 ◽

2011 ◽

Vol 18 (02) ◽

pp. 323-327

Author(s):

WAQAR ALAM ◽

FAAIZ ALI SHAH ◽

ZAFAR DURRANI ◽

Zahid Askar ◽

Muhammad Ayaz Khan ◽

...

Keyword(s):

Kirschner Wire ◽

Unstable Fracture ◽

Fractures In Children ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Ulna Fractures ◽

K Wires ◽

Age Range ◽

Radiological Union

Objectives: To know the functional outcome of Intramedullary Kirschner Wire fixation of unstable Radius-Ulna fractures in children. Study Design: Descriptive study. Period: 27/03/2009 to 26/03/2010. Setting: Department of Orthopedic and Trauma, Khyber Teaching Hospital, Peshawar. Patients and Methods: All patients were admitted from OPD . Children less than 16 years with Unstable Radius- Ulna fractures were included in the study. Patients with open fractures and adults with polytrauma were excluded from the study. Unstable Radius-Ulna fractures were treated by Intramedullary Kirschner Wire fixation under general anesthesia and tourniquet control. Follow up till radiological and clinical union was done. K-wires were removed after healing of fractures. Patients were assessed functionally and radiologically and results were graded according to Price et al Criteria. Results: A total of 64 children with unstable radius and ulna fractures were included in the study. The age range was 6 to 15 years with average age of 10.41 years. 47 were male and 17 were female. The average time of radiological union was 7 weeks and K-wires were removed at 8 weeks time. At final assessment there were 47 Excellent, 10 Good and 7 Fair results. Conclusions: Excellent results can be achieved by Intramedullary K-Wires fixation. In children with unstable Radius-Ulna fractures. It should be the method of choice for treating these fractures.

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Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation?

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1714656 ◽

2020 ◽

Author(s):

Danielle S. Wendling-Keim ◽

Sandra Teschemacher ◽

Hans-Georg Dietz ◽

Markus Lehner

Keyword(s):

Range Of Motion ◽

Screw Fixation ◽

Statistical Significance ◽

Kirschner Wire ◽

Lower Percentage ◽

Lateral Condyle ◽

Fractures In Children ◽

Kirschner Wire Fixation ◽

Wire Fixation ◽

Condyle Fracture

Abstract Introduction The treatment of the displaced fracture of the lateral condyle of the distal humerus in children aims not only to avoid nonunion, malalignment, and impairment of the range of motion of the elbow but also to prevent delayed healing and the development of any prearthrotic deformity. To date there is no agreement on what kind of osteosynthesis should be used. So far, the screw fixation and Kirschner wire fixation have both been applied. Therefore, the goal of this study was to compare the outcome of these two methods. Materials and Methods A retrospective cohort study was undertaken including 43 patients aged 2 to 13 years who underwent osteosynthesis for a condylar fracture of the humerus over a period of 10 years. The electronic archive, including the radiological diagnostics, was analyzed. Statistical analysis was performed using IBM SPSS Statistics 20.0. Statistical significance was set at an α level of p = 0.05. Results Kirschner wire fixation was performed in 48.9% of condylar fractures of the humerus while screw fixation (alone or in combination with a pin) was assessed with a percentage of 51.1% of the cases in this study. Screw fixation only was applied in 20.9% of fractures of the lateral condyle. The selection of the method was independent of the age of the patient (p = 0.2). The comparison of the rate of complications and an impaired range of motion after Kirschner wire osteosynthesis to the rate after screw osteosynthesis showed a significantly lower percentage for the Kirschner wire group (p = 0.046). No case of nonunion, nerve palsy, or pin migration was detected in any patient in this study. Conclusion Kirschner wire fixation of condylar humeral fractures in children resulted in a lower rate of complications than screw fixation. No case of nonunion of the fracture was found in the patients that we investigated so that we conclude that Kirschner wires sufficiently adapt the fracture in these cases. Level of Evidence Level III.

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