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Comparative study between two patterns of percutaneous K-wire fixation of supracondylar fracture of the humerus in children

Author: Mushtaq Talib Hussein
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2016 Volume: 15 Issue: 2 Pages: 14-19
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Supracondylar fracture of the humerus is the second most common fracture in children. Failure to execute a appropriate treatment plan for these fractures may lead tovarus malunion. For that closed reduction and percutaneous pinning is the treatment of choice. Percutaneous K-wire fixation can be inserted either in a cross medial-lateral pattern or through a lateral entry only with each method having its advantage and disadvantage. Aim: Is to evaluate the results of two lateral parallel pin fixation versus cross medial lateral pin fixation in displaced supracondylar humerus fracture in children regarding complications (especially iatrogenic nerve injury, cubitus varus deformity), technique and other concepts. Patients and method: Between March 2010 to May2014, forty _ three (38) patients at Al-Yarmouk Teaching hospital were collected from emergency unite and from orthopedic outpatient to undergo surgery for displaced supracondylar fracture humerus (type B , C) according to gartland classification. it was an urgent operation with less than 24 hours, traumatic posterior supracondylar fracture humerus(type B,C) with no vascular or nerve injury for children aged less than 12 years old. They were divided into two groups [Group I(20 patients) closed reduction and percutaneous two lateral parallel k_wire fixation] and[Group II(18 patients) with two cross medial_ lateral k_wire fixation] and we compare the results between the two groups post operatively. Results: There were significant differences(P-value=0.0078)regarding complications postoperatively , there were typical cubitus varus deformity 2{10%} in group I while there were no such complication{0%} in group II, while we report one case {5.55%} with ulnar nerve neuropraxia in group II. Regarding functional results; there were significant differences between the two groups, we reported excellent results 11{55%} in group I, while it was 13{72.22%} in group II, good results were about 5{25%} in group I ,while it was 4{27.77%} in group II, fair results 2{10%} in group I, 1{5.55%} in group II. In addition there were significant poor results in group I as we reported 2 cases{10%} in group I, while there were no such results{ 0%} in group II. Conclusion: Closed reduction and medial-lateral percutaneous K-wire fixation is the treatment of choice for displaced pediatric supracondylar fractures of the humerus with extra precautions during medial wire insertion..

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