Subscribe to RSS
Lateral Condyle Fracture of the Humerus in Children: Kirschner Wire or Screw Fixation?
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.
This study has been approved by the ethical committee of our institution. This article does not contain any studies with human participants or animals due to its retrospective design. All data have been irreversibly anonymized.
Received: 13 April 2020
Accepted: 18 June 2020
28 July 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Fucs PMMB, Scarlat MM. Pediatric orthopaedics - from Kirschner wires to titanium. Int Orthop 2017; 41 (12) 2429-2431
- 2 Lemme K, Lubicky JP, Zeni A, Riley E. Pediatric lateral condyle humeral fractures with and without associated elbow dislocations: a retrospective study. Am J Orthop 2009; 38 (09) 453-456
- 3 Kraus R, Wessel L. The treatment of upper limb fractures in children and adolescents. Dtsch Arztebl Int 2010; 107 (51-52): 903-910
- 4 Gogola GR. Pediatric humeral condyle fractures. Hand Clin 2006; 22 (01) 77-85
- 5 Shaerf DA, Vanhegan IS, Dattani R. Diagnosis, management and complications of distal humerus lateral condyle fractures in children. Shoulder Elbow 2018; 10 (02) 114-120
- 6 Schneidmueller D, Boettger M, Laurer H, Gutsfeld P, Bühren V. Distal humerus fractures in children [in German]. Orthopade 2013; 42 (11) 977-985
- 7 Weiss JM, Graves S, Yang S, Mendelsohn E, Kay RM, Skaggs DL. A new classification system predictive of complications in surgically treated pediatric humeral lateral condyle fractures. J Pediatr Orthop 2009; 29 (06) 602-605
- 8 Knapik DM, Gilmore A, Liu RW. Conservative management of minimally displaced (≤2 mm) fractures of the lateral humeral condyle in pediatric patients: a systematic review. J Pediatr Orthop 2017; 37 (02) e83-e87
- 9 Gilbert SR, MacLennan PA, Schlitz RS, Estes AR. Screw versus pin fixation with open reduction of pediatric lateral condyle fractures. J Pediatr Orthop B 2016; 25 (02) 148-152
- 10 Stein BE, Ramji AF, Hassanzadeh H, Wohlgemut JM, Ain MC, Sponseller PD. Cannulated lag screw fixation of displaced lateral humeral condyle fractures is associated with lower rates of open reduction and infection than pin fixation. J Pediatr Orthop 2017; 37 (01) 7-13
- 11 Hasler C, von Laer L. Screw osteosynthesis in dislocated fractures of the radial condyle of the humerus in the growth period. A prospective long-term study [in German]. Unfallchirurg 1998; 101 (04) 280-286
- 12 Wirmer J, Kruppa C, Fitze G. Operative treatment of lateral humeral condyle fractures in children. Eur J Pediatr Surg 2012; 22 (04) 289-294
- 13 Li WC, Xu RJ. Comparison of Kirschner wires and AO cannulated screw internal fixation for displaced lateral humeral condyle fracture in children. Int Orthop 2012; 36 (06) 1261-1266
- 14 Justus C, Haruno LS, Riordan MK. et al. Closed and open reduction of displaced pediatric lateral condyle humeral fractures, a study of short-term complications and postoperative protocols. Iowa Orthop J 2017; 37: 163-169
- 15 Launay F, Leet AI, Jacopin S, Jouve JL, Bollini G, Sponseller PD. Lateral humeral condyle fractures in children: a comparison of two approaches to treatment. J Pediatr Orthop 2004; 24 (04) 385-391
- 16 Bloom T, Chen LY, Sabharwal S. Biomechanical analysis of lateral humeral condyle fracture pinning. J Pediatr Orthop 2011; 31 (02) 130-137
- 17 Anderson KR, Schoch JJ, Lohse CM, Hand JL, Davis DM, Tollefson MM. Increasing incidence of infantile hemangiomas (IH) over the past 35 years: correlation with decreasing gestational age at birth and birth weight. J Am Acad Dermatol 2016; 74 (01) 120-126
- 18 Wang YL, Chang WN, Hsu CJ, Sun SF, Wang JL, Wong CY. The recovery of elbow range of motion after treatment of supracondylar and lateral condylar fractures of the distal humerus in children. J Orthop Trauma 2009; 23 (02) 120-125
- 19 Kröpfl A, Genelin F, Obrist J, Zirknitzer J. Malunion and growth disorders following fractures of the condylus radialis humeri in children [in German]. Unfallchirurgie 1989; 15 (03) 113-121
- 20 Wendling-Keim DS, Binder M, Dietz HG, Lehner M. Prognostic factors for the outcome of supracondylar humeral fractures in children. Orthop Surg 2019; 11 (04) 690-697
- 21 Ganeshalingam R, Donnan A, Evans O, Hoq M, Camp M, Donnan L. Lateral condylar fractures of the humerus in children: does the type of fixation matter?. Bone Joint J 2018; 100-B (03) 387-395
- 22 Tejwani N, Phillips D, Goldstein RY. Management of lateral humeral condylar fracture in children. J Am Acad Orthop Surg 2011; 19 (06) 350-358
- 23 Kamara A, Ji X, Liu T, Zhan Y, Li J, Wang E. A comparative biomechanical study on different fixation techniques in the management of transverse metaphyseal-diaphyseal junction fractures of the distal humerus in children. Int Orthop 2019; 43 (02) 411-416
- 24 Das De S, Bae DS, Waters PM. Displaced humeral lateral condyle fractures in children: should we bury the pins?. J Pediatr Orthop 2012; 32 (06) 573-578
- 25 Cambon-Binder A, Jehanno P, Tribout L. et al. Pulseless supracondylar humeral fractures in children: vascular complications in a ten year series. Int Orthop 2018; 42 (04) 891-899