KIRSCHNER WIRES <i>VERSUS</i> SCREW FIXATION FOR LATERAL HUMERAL CONDYLE FRACTURES IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

Souza, Jessiel Gonçalves de; Nascimento, Adriano Assis; Seike, Marina Garcia; Takihi, Fabio Akio; Cavalcante, Israel Quirino; Dobashi, Eiffel Tsuyoshi

doi:10.1590/1413-785220263403e300984

Tabla de contenido Anterior Actual Siguiente

Systematic Review Article/Pediatric Orthopedic • Acta Ortop Bras 34 (3) • May-Jun 2026 • https://doi.org/10.1590/1413-785220263403e300984 linkcopy

KIRSCHNER WIRES VERSUS SCREW FIXATION FOR LATERAL HUMERAL CONDYLE FRACTURES IN CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS

FIOS DE KIRSCHNER VERSUS FIXAÇÃO COM PARAFUSO PARA FRATURAS DO CÔNDILO LATERAL DO ÚMERO EM CRIANÇAS: UMA REVISÃO SISTEMÁTICA E META-ANÁLISE

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: Lateral condyle fractures of the humerus are the second most common elbow fracture in children. Both Kirschner wires (K-wires) and cannulated screws are widely used for fixation, but the optimal technique remains debated. This study aimed to compare these methods in terms of functional outcomes and complications.

Material and Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.

Results: Thirteen comparative studies involving 1,230 pediatric patients were included. Outcomes were analyzed using random-effects models, with risk ratios (RRs) and 95% confidence intervals (CIs). Meta-regression and prediction intervals (PIs) were applied to explore heterogeneity. Screw fixation significantly reduced the risk of postoperative infection (RR = 0.27; 95% CI: 0.12–0.60) and was associated with better functional outcomes (RR = 1.09; 95% CI: 1.01–1.18). No significant differences were observed in overall complications (RR = 0.89; 95% CI: 0.66–1.20), lateral overgrowth, range of motion limitation, or nonunion. Meta-regression did not identify age or fracture severity as effect modifiers.

Conclusion: Cannulated screw fixation may be preferable for reducing infection and improving outcomes, but individualized clinical decisions and further high-quality research remain essential. Level of Evidence III; Systematic Review.

Keywords:
Humeral Fractures; Fracture Fixation, Internal; Elbow Joint; Bone Screws; Kirschner Wires; Pediatrics

Authors/Year	Country	Study Design	Follow-up	Included Patients		Mean Age (years)*		Gender†		Milch Classification
Authors/Year	Country	Study Design	Follow-up	Screw	Kirshner Wire	Screw	Kirshner Wire	Screw	Kirshner Wire	Screw	Kirshner Wire
Afaque and Singh 2020	India	Open trial	18 mo‡	21	19	7.5a	7.9a	15 / 8	13 / 4	Type I: 8 Type II: 13	Type I: 7 Type II: 12
Cummings et al. 2023	United States	Retrospective cohort	12 mo	209	553	7.81 ± 3.61	8.78 ± 3.63	350 / 203	126 / 83	Type I: 102b Type II: 646
Ganeshalingam et al. 2018	Canada	Retrospective cohort	4.8 y‡	101	235	7.15 ± 3.17	5.84 ± 2.77	62 / 39	143 / 92	Type I: 11 Type II: 89	Type I: 80 Type II: 154
Gilbert et al. 2016	United States	Retrospective cohort	6.8 mo‡	41	43	6.2 ± 3.03	5.2 ± 2.33	29 / 12	30 / 13	-	-
Gupta et al. 2023	India	Open trial	12 mo	23	23	6.26a	6.87a	15 / 8	19 / 4	Type I: 7 Type II: 16	Type I: 5 Type II: 18
Li et al. 2011	China	Retrospective cohort	39.4 mo‡	32	30	7.02a	6.83a	18 / 14	24 / 6	Type I: 9 Type II: 23	Type I: 5 Type II: 25
Pace et al. 2018	United States	Retrospective cohort	10 w‡	14	318	-	-	-	-	-	-
Stein et al. 2017	United States	Retrospective cohort	7.3 mo‡	26	22	5.9 ± 2.73	5.1 ± 1.73	20 / 6	13 / 9	Type I: 0 Type II: 26	Type I: 0 Type II: 22
Thapa et al. 2019	Nepal	Open trial	12 mo	23	23	6.26a	6.87a	15 / 8	19 / 4	Type I: 7 Type II: 16	Type I: 5 Type II: 18
Vergara and Fretes 2023	Paraguay	Open trial	6 mo	11	19	7.27 ± 2.80	6.42 ± 1.50	7 / 4	13 / 6	Type I: 5 Type II: 6	Type I: 7 Type II: 12
Wendling-Keim et al. 2020	Germany	Retrospective cohort	18 mo	13**	21	6.91 ± 2.83	5.67 ± 3.47	-	-	-	-

	Effect estimates	P-value	I (%)	Residual heterogeneity test
Average Age (Function)
Intercept Average Age	2.31 −0.32	0.21 0.27	65.83	P=0.0300
Proportion of Milch type II (Function)
Intercept Milch type II	-1.40 0.02	0.37 0.25	74.07	p = 0.0175
Middle Ages (Complications)
Intercept Average Age	0.33 −0.12	0.88 0.72	79.73	p < 0.0001
Milch type II ratio (Complications)
Intercept Milch type II	0.12 −0.01	0.92 0.60	78.02	p < 0.0016

location_on

ATHA EDITORA Rua: Machado Bittencourt, 190, 4º andar - Vila Mariana - São Paulo Capital - CEP 04044-000, Telefone: 55-11-5087-9502 - São Paulo - SP - Brazil
E-mail: actaortopedicabrasileira@uol.com.br

rss_feed Acompañe los números de esta revista en su lector de RSS

[TFN1] Legend: y = years; mo = months; w = weeks.

[TFN2] ^*
Mean ± Standard Deviation;

[TFN3] ^**
4 patients in the group used screw + K wire;

[TFN4] ^†
Male/Female;

[TFN5] ^‡
The authors reported the average follow-up; aThe author did not provide the standard deviation; bThe author did not stratify the classification for the groups.