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Displaced humeral lateral condyle fractures in children: should we bury the pins?
Soumen Das De1, Donald S Bae, Peter M Waters
1Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA 02115, USA.
Insights
Leaving Kirschner wires exposed after open reduction and internal fixation (ORIF) for humeral lateral condyle fractures is safe and cost-effective. This approach offers significant cost savings compared to burying the wires subcutaneously.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Trauma Surgery
Background:
- Humeral lateral condyle fractures are common in children.
- Open reduction and internal fixation (ORIF) is a standard treatment.
- Kirschner wire fixation is frequently used, with variations in post-operative management.
Purpose of the Study:
- To compare the cost-effectiveness of leaving Kirschner wires exposed versus burying them subcutaneously.
- To evaluate safety and complication rates associated with each method.
Main Methods:
- Retrospective cohort study of 235 children over 10 years.
- Analysis of surgical technique, fracture healing, complications, and treatment costs.
- Decision analysis model with sensitivity analyses for cost-effectiveness.
Main Results:
- Exposed pins had shorter removal times (4 vs. 6 weeks) without affecting union rates.
- Superficial infection rates were higher but not significant (9.8% vs. 3.1%); no deep infections with exposed pins.
- Buried pins had more complications (symptomatic implants, migration, skin necrosis).
- Exposed pins saved an average of $3442 per patient and remained cost-effective even with high infection rates.
Conclusions:
- Leaving Kirschner wires exposed after ORIF for lateral condyle fractures is a safe and more cost-effective strategy.
- This method reduces complications and healthcare costs compared to subcutaneous burial.
Background:
The purpose of this investigation was to determine if leaving Kirschner wires exposed is more cost-effective than burying them subcutaneously after open reduction and internal fixation (ORIF) of humeral lateral condyle fractures.
Methods:
A retrospective cohort study of all lateral condyle fractures treated over a 10-year period at a single institution was performed. Data on surgical technique, fracture healing, and complications were analyzed, as well as treatment costs. A decision analysis model was then constructed to compare the strategies of leaving the pins exposed versus buried. Finally, sensitivity analyses were performed, assessing cost-effectiveness when infection rates and costs of treating deep infections were varied.
Results:
A total of 235 children with displaced fractures were treated with ORIF using Kirschner wires. Pins were left exposed in 41 cases (17.4%) and buried in 194 cases (82.6%); the age, sex, injury mechanisms, and fracture patterns were similar in both the groups. The median time to removal of implants was shorter with exposed versus buried pins (4 vs. 6 wk, P<0.001), although there was no difference in fracture union or loss of reduction rates. The rate of superficial infection was higher with exposed pins (9.8% vs. 3.1%), but this was not statistically significant (P=0.076). There were no deep infections with exposed pins, whereas the rate of deep infection was 0.5% with buried pins (P=1.00). Buried pins were associated with additional complications, including symptomatic implants (7.2%); pins protruding through the skin (16%); internal pin migration necessitating additional surgery (1%); and skin necrosis (1%). The decision analysis revealed that leaving pins exposed resulted in an average cost savings of $3442 per patient. This strategy remained cost-effective even when infection rates with exposed pins approached 40%.
Conclusions:
Leaving the pins exposed after ORIF of lateral condyle fractures is safe and more cost-effective than burying the pins subcutaneously.
Level Of Evidence:
Retrospective cohort study (level III).
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