Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children

Vergara, Alberto Daniel Navarro; Fretes, Alberto Navarro

doi:10.1055/s-0042-1757307

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Original Article • Rev. bras. ortop. 58 (1) • Jan-Feb 2023 • https://doi.org/10.1055/s-0042-1757307 copy

Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children^* * Work developed at Hospital de Trauma Manuel Giagni, Assunción, Paraguay.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To compare the use of cannulated screws and smooth Kirschner wires in terms of reducing the presence of exuberant callus and complications in pediatric displaced fractures of the lateral humeral condyle.

Methods

An analytical cross-sectional study of consecutive cases was conducted from May to October 2021 with 30 children with displaced external humeral condyle fractures. The functional results regarding pain and range of motion were stratified using the Dhillon grading system.

Results

A total of 19 patients underwent Kirschner wire fixation, and 11 underwent cannulated screw fixation. Closed fixation was performed in 14 cases (47%), and open fixation, in 16 (53%). Of the cases included, there was no loss to follow-up. Te sample was composed of 21 (70%) male patients, and the age ranged from 5 to 15 years, with a mean of 6.96 years. The most frequent cause of fracture was fall from height (50%), which was related to greater displacement on baseline radiographs. Complications that were not related to the reduction approach or the implant used were observed in 12 (40%) cases.

Conclusion

The present study shows no benefits in relation to the use of smooth pins or cannulated screws to reduce the presence of exuberant callus in the consolidation of the fracture. We see that the complications that arise are related to the severity of the injury, and benefits cannot be identified in the choice of one implant over another. We could see that the Weiss classification helps to define the behavior in favor of open or closed reduction without interfering in kindness of the smooth pin or the cannulated screw for fracture fixation.

Keywords
bone screws; bone wires; child; elbow joint; fractures, bone; humeral fractures

Case	Gender	Age (years)	Side	Mechanism of trauma	Weiss classification	Time until surgery
1	Male	7	Right	Fall from height	III	4
2	Male	14	Left	Fall from motorcycle	II	10
3	Female	5	Right	Fall from own height	II	1
4	Male	5	Right	Fall from height	III	1
5	Male	5	Left	Fall from bicycle	II	5
6	Male	5	Right	Fall from bicycle	III	4
7	Female	5	Left	Fall from own height	II	6
8	Male	9	Left	Fall from height	II	0
9	Male	7	Left	Fall from own height	II	5
10	Male	5	Left	Direct trauma	II	1
11	Female	7	Left	Fall from own height	II	1
12	Male	8	Left	Fall from own height	II	1
13	Female	5	Right	Fall from height	III	4
14	Female	6	Left	Fall from own height	II	1
15	Male	5	Left	Fall from height	III	2
16	Male	9	Right	Direct trauma	III	2
17	Male	11	Left	Fall from height	II	4
18	Male	5	Right	Fall from own height	II	0
19	Male	5	Left	Fall from height	III	1
20	Male	7	Right	Fall from own height	II	4
21	Female	6	Left	Fall from height	III	3
22	Male	5	Left	Fall from height	II	2
23	Male	8	Left	Fall from own height	II	2
24	Female	5	Right	Fall from height	III	2
25	Female	5	Right	Fall from height	III	1
26	Male	10	Right	Fall from height	II	5
27	Male	15	Right	Fall from motorcycle	II	1
28	Male	6	Left	Fall from height	II	9
29	Male	7	Left	Fall from height	III	3
30	Female	7	Left	Fall from height	III	3

Case	Weiss classification	Treatment	Reduction	Complications	Dhillon system
1	III	Kirschner wire	Open	Exuberant callus	Excellent
2	II	Cannulated screw	Open	Nervous injury	Fair
3	II	Ki rschnerwire	Closed	-	Excellent
4	III	Kirschner wire	Open	-	Excellent
5	II	Cannulated screw	Closed	Exuberant callus	Excellent
6	III	Kirschner wire	Open	Exuberant callus	Excellent
7	II	Cannulated screw	Closed	-	Excellent
8	II	Kirschner wire	Closed	Reduced mobility	Good
9	II	Cannulated screw	Closed	-	Excellent
10	II	Kirschner wire	Open	Exuberant callus	Excellent
11	II	Kirschner wire	Closed	-	Excellent
12	II	Kirschner wire	Closed	-	Excellent
13	III	Cannulated screw	Open	Exuberant callus	Excellent
14	II	Kirschner wire	Open	-	Excellent
15	III	Cannulated screw	Open	Nonunion	Poor
16	III	Kirschner wire	Open	-	Good
17	II	Cannulated screw	Closed	-	Excellent
18	II	Kirschner wire	Closed	-	Excellent
19	III	Kirschner wire	Open	Elbow stiffness	Fair
20	II	Kirschner wire	Closed	-	Excellent
21	III	Cannulated screw	Open	Elbow stiffness	Fair
22	II	Kirschner wire	Closed	Partial loss of fixation	Excellent
23	II	Kirschner wire	Closed	-	Excellent
24	III	Cannulated screw	Open	Elbow stiffness	Fair
25	III	Kirschnerwire	Open	-	Excellent
26	II	Cannulated screw	Closed	-	Excellent
27	II	Cannulated screw	Closed	-	Excellent
28	II	Kirschner wire	Open	-	Excellent
29	III	Kirschner wire	Open	-	Excellent
30	III	Kirschner wire	Open	-	Excellent

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Alberto Daniel Navarro Vergara, MD, Hospital de Trauma Manuel Giagni/Hospital Central de IPS, Coronel Ángel López 1.161, Asunción, Paraguay (e-mail: djocote@hotmail.com).

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Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children* * Work developed at Hospital de Trauma Manuel Giagni, Assunción, Paraguay.

Abstract

Objective

Methods

Results

Conclusion

Comparison between Fixation with Smooth Kirschner Wire and Cannulated Screws in Displaced Fractures of the Lateral Humeral Condyle in Children^* * Work developed at Hospital de Trauma Manuel Giagni, Assunción, Paraguay.