Does the configuration of the K-Wires in the coronal plane affect the time to union in supracondylar humerus fractures?

Serhat Akçaalan; Ceyhun Çağlar; Mehmet Can Kengil; Mustafa Akkaya; Mehmet İsmail Safa Kapıcıoğlu; Metin Doğan

doi:10.19161/etd.1563203

EN TR

Does the configuration of the K-Wires in the coronal plane affect the time to union in supracondylar humerus fractures?

Abstract

Aim: Supracondylar humerus fractures (SHF) are among the most common bone fractures in the pediatric population. However, there is no consensus in the literature regarding the configuration of the K wires used in this method. Materials and Methods: Patients who underwent closed reduction using two lateral and one medial percutaneous pins for SHF were included in the study. Measurements were made on the antero-posterior elbow radiographs of the patients taken on post-operative day 0. These measurements involved the angles of each K-wire with one another, the angles of the K-wires with the fracture line, and the angles between the K-wires and the humeral shaft. Postoperative complications, splint removal and pin removal times of all patients were recorded. Results: A total of 167 patients were included in the study. Uneventful fracture healing was achieved in all remaining patients. No significant relationship or correlation was found between the above-mentioned angular parameters and fracture union time. However, the angle between the pins placed laterally, the angle between the medial pin, and lateral pin 2, and the angle between lateral pin 2 and the humeral shaft were found to be larger in patients with complications than in patients without complications (p=0.0001, p=0.017, p=0.0001). Conclusion: The quality of fracture reduction is the basis for postoperative functional recovery. The results of this study that the main parameter affecting union in SHF is not the configuration of the pins in the coronal plane, but the anatomical fracture reduction and stable fixation obtained.

Keywords

Suprakondiler humerus kırıklarında K-Tellerinin koronal düzlemdeki konfigürasyonu kaynama süresini etkiler mi?

Öz

Amaç: Suprakondiler humerus kırıkları (SHK), pediatrik popülasyonda en sık görülen kemik kırıkları arasındadır. Ancak bu yöntemde kullanılan K tellerinin konfigürasyonu konusunda literatürde fikir birliği yoktur. Gereç ve Yöntem: SHK tanısıyla kapalı redüksiyon ile iki lateral ve bir medial perkütan pin fiksasyonu uygulanan hastalar çalışmaya dahil edildi. Hastaların ameliyat sonrası 0. günde çekilen ön-arka dirsek grafilerinde ölçümler yapıldı. Her bir K telinin birbiriyle olan açıları, K tellerinin kırık hattı ile olan açıları ve K tellerinin humerus şaftı ile olan açıları ayrı ayrı ölçüldü. Tüm hastaların ameliyat sonrası komplikasyonları, splint çıkarma ve pin çıkarma süreleri kaydedildi. Bulgular: Çalışmaya toplam 167 hasta dahil edildi. Tüm hastalarda sorunsuz kırık iyileşmesi görüldü. Yukarıda belirtilen açısal parametreler ile kırık kaynama süresi arasında anlamlı bir ilişki veya korelasyon bulunamadı. Ancak laterale yerleştirilen pinler arasındaki açı, medial pin ile lateral pin 2 arasındaki açı ve lateral pin 2 ile humerus şaftı arasındaki açı komplikasyonu olan hastalarda komplikasyonu olmayan hastalara göre daha büyük bulundu (p= 0,0001, p=0,017, p=0,0001). Sonuç: Kırık redüksiyonunun kalitesi postoperatif fonksiyonel iyileşmenin temelini oluşturur. Bu çalışmanın sonuçları, SHK'da kaynamayı etkileyen ana parametrenin pinlerin koronal düzlemdeki konfigürasyonu değil, anatomik kırık redüksiyonu ve başarılı fiksasyon olduğunu göstermektedir.

Anahtar Kelimeler

Ethical Statement

Çalışma için etik kurul onayı mevcuttur

References

Barr L V. Paediatric supracondylar humeral fractures: epidemiology, mechanisms and incidence during school holidays. J Child Orthop. 2014;8:167–70.
Zorrilla S, de Neira J, Prada-Cañizares A, Marti-Ciruelos R, Pretell-Mazzini J. Supracondylar humeral fractures in children: current concepts for management and prognosis. Int Orthop. 2015;39:2287–96.
Abzug JM, Herman MJ. Management of supracondylar humerus fractures in children: current concepts. J Am Acad Orthop Surg. 2012;20:69–77.
Mehlman CT, Denning JR, McCarthy JJ, Fisher ML. Infantile Supracondylar Humeral Fractures (Patients Less Than Two Years of Age): Twice as Common in Females and a High Rate of Malunion with Lateral Column- Only Fixation. J Bone Joint Surg Am. 2019;101:25–34.
Zhao JG, Wang J, Zhang P. Is lateral pin fixation for displaced supracondylar fractures of the humerus better than crossed pins in children? Clin Orthop Relat Res. 2013;471:2942–53.
Otsuka NY, Kasser JR. Supracondylar Fractures of the Humerus in Children. J Am Acad Orthop Surg. 1997;5:19–26.
GARTLAND JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109:145–54.
Patriota GSQA, Assunção Filho CA, Assunção CA. What is the best fixation technique for the treatment of supracondylar humerus fractures in children? Rev Bras Ortop (Sao Paulo). 2017;52:428–34.

Lee SS, Mahar AT, Miesen D, Newton PO. Displaced pediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop. 2002;22:440–3.
Nagda T. Controversial Issues in Closed Reduction and percutaneous pinning of Supracondylar Fractures of Humerus in children. Int J Pediatr Orthop. 2023. Available from: http://ijpoonline.com/controversial-issues- closed-reduction-percutaneous-pinning-supracondylar-fractures-humerus-children/.
Kocher MS, Kasser JR, Waters PM, Bae D, Snyder BD, Hresko MT, Hedequist D, Karlin L, Kim YJ, Murray MM, Millis MB, Emans JB, Dichtel L, Matheney T, Lee BM. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. J Bone Joint Surg Am 2007;89:706–12.
Dekker AE, Krijnen P, Schipper IB. Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures: A systematic review and meta-analysis. Injury. 2016;47:2391–8.
Dineen HA, Stone J, Ostrum RF. Closed Reduction Percutaneous Pinning of a Pediatric Supracondylar Distal Humerus Fracture. J Orthop Trauma 2019;33 Suppl 1:S7–S8.
Durusoy S, Öner K, Özer A, Sevinç HF. The effect of the angle between fracture line and Kirschner wires on stability in supracondylar humerus fractures treated with Kirschner wire fixation: A finite element analysis. Jt Dis Relat Surg. 2021;32:75–84.
Lee YH, Lee SK, Kim BS, et al. Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children. J Pediatr Orthop 2008;28:417–22.
Gopinathan NR, Sajid M, Sudesh P, Behera P. Outcome Analysis of Lateral Pinning for Displaced Supracondylar Fractures in Children Using Three Kirschner Wires in Parallel and Divergent Configuration. Indian J Orthop. 2018;52:554–60.
Hannonen J, Pokka T, Serlo W, Sinikumpu JJ. Lateral-Only Kirschner-Wire Fixation of Type-3 Supracondylar Humerus Fractures in Children with a Special Attention to Technical Issues. Scand J Surg. 2021;110:258–64.
Gottschalk HP, Sagoo D, Glaser D, Doan J, Edmonds EW, Schlechter J. Biomechanical analysis of pin placement for pediatric supracondylar humerus fractures: does starting point, pin size, and number matter? J Pediatr Orthop. 2012;32:445–51.
Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am. 2001;83:735–40.
Gaston RG, Cates TB, Devito D, Schmitz M, Schrader T, Busch M, Fabregas J, Rosenberg E, Blanco J. Medial and lateral pin versus lateral-entry pin fixation for Type 3 supracondylar fractures in children: a prospective, surgeon-randomized study. J Pediatr Orthop. 2010;30:799–806.
Na Y, Bai R, Zhao Z, Han C, Kong L, Ren Y, Liu W. Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis. J Orthop Surg Res. 2018;13:68.
Pennock AT, Charles M, Moor M, Bastrom TP, Newton PO. Potential causes of loss of reduction in supracondylar humerus fractures. J Pediatr Orthop. 2014;34:691–7.
Woratanarat P, Angsanuntsukh C, Rattanasiri S, Attia J, Woratanarat T, Thakkinstian A. Meta-analysis of pinning in supracondylar fracture of the humerus in children. J Orthop Trauma. 2012;26:48–53.
Bitzer AM, Belkoff SM, LiBrizzi CL, Chibututu C, Lee RJ. Sagittal plane alignment affects the strength of pin fixation in supracondylar humerus fractures. Medicine. 2021;100:e26173.
Wang SB, Lin BH, Liu W, Wei GJ, Li ZG, Yu NC, Ji GR. Modified Closed Reduction and Percutaneous Kirschner Wires Internal Fixation for Treatment of Supracondylar Humerus Fractures in Children. Curr Med Sci. 2021;41:777–81.
Sankar WN, Hebela NM, Skaggs DL, Flynn JM. Loss of pin fixation in displaced supracondylar humeral fractures in children: causes and prevention. J Bone Joint Surg Am. 2007;89:713–7.

Details

Primary Language

English

Subjects

Orthopaedics

Journal Section

Research Article

Authors

Serhat Akçaalan
0000-0001-7350-6422
Türkiye

Ceyhun Çağlar ^*
0000-0003-4286-7852
Türkiye

Mehmet Can Kengil
0009-0007-5354-1985
Türkiye

Mustafa Akkaya
0000-0002-2694-4208
Türkiye

Mehmet İsmail Safa Kapıcıoğlu
0000-0003-1515-9391
Türkiye

Metin Doğan
0000-0003-1634-2577
Türkiye

Publication Date

March 12, 2025

Submission Date

October 17, 2024

Acceptance Date

January 31, 2025

Published in Issue

Year 2025 Volume: 64 Number: 1

DOI

https://doi.org/10.19161/etd.1563203

IZ

https://izlik.org/JA75AG72FZ

Cite

RIS / Bibtex

Vancouver

1.Serhat Akçaalan, Ceyhun Çağlar, Mehmet Can Kengil, Mustafa Akkaya, Mehmet İsmail Safa Kapıcıoğlu, Metin Doğan. Does the configuration of the K-Wires in the coronal plane affect the time to union in supracondylar humerus fractures? EJM. 2025 Mar. 1;64(1):128-34. doi:10.19161/etd.1563203