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A Retrospective Study Comparing Crossed and Lateral Wire Configurations in Paediatric Supracondylar Fractures
Murtaza K Khwaja1, Wasim S Khan1, Pinak Ray1
1Department of Trauma and Orthopaedics, Royal Free Hospitals NHS Trust, Barnet Hospital, Barnet, London, UK.
Insights
Wire configurations for pediatric supracondylar fractures impact outcomes. Crossed wires correlated with nerve injuries, while lateral wires were linked to displacements, highlighting the importance of post-operative imaging.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Pediatric trauma
Background:
- Supracondylar fractures are prevalent in children, often leading to significant morbidity.
- Effective management is crucial to minimize long-term complications.
Purpose of the Study:
- To compare clinical and radiological outcomes of supracondylar fracture management using different wire configurations.
- To identify factors contributing to complications in pediatric patients.
Main Methods:
- Retrospective review of 123 pediatric supracondylar fracture cases over five years.
- Analysis of patient age, fracture classification, treatment, surgical details, wire configuration, and radiological parameters.
- Assessment of complications including nerve injuries and fracture displacements.
Main Results:
- 23% of patients treated with wire stabilization experienced complications; 13% had significant issues like nerve injuries or displacements.
- All nerve injuries occurred with crossed wires; all displacements occurred with lateral wires.
- Inadequate post-operative radiological alignment (Baumann's angle, radiocapitellar line, anterior humeral line) was associated with higher complication rates.
Conclusions:
- Lateral pinning configurations showed more complications, while crossed wires were exclusively associated with nerve injuries.
- Suboptimal post-operative radiological appearance is a key factor predicting increased complication likelihood in pediatric supracondylar fractures.
Background:
Supracondylar fractures are common in children and are associated with significant morbidity. The purpose of our study was to assess and compare the clinical and radiological outcome of management of supracondylar fractures by both wire configurations, along with identifying factors that predispose to complications.
Materials & Methods:
We retrospectively reviewed all paediatric cases admitted with a supracondylar fracture over a five year period. We reviewed case notes, theatre records and radiographs to determine the age of the patient, classification of fracture, treatment method, delay to theatre, duration of surgery, wire configuration, Baumann´s angle, radiocapitellar alignment, anterior humeral alignment and complications.
Results:
During the five year period we admitted 132 patients and complete notes were available for 123 patients for analyses. For all the patients managed with wire stabilisation 23% developed complications, including 13% with significant complications including nerve injuries and fracture displacements. All five nerve injuries had crossed wires, whereas all for fracture displacements had lateral wires. Baumann´s angle was 76.7 degrees in the group with no complication and 72.2 degrees in the significant complication group (p=0.02). Radiocapitellar line and anterior humeral line were not satisfactory in 5% and 15% of the group with no complications, and 17% and 33% of the group with significant complications.
Conclusion:
We found more complications in lateral pinning configurations, although all nerve injuries were in patients with crossed wire configurations. The factors we believe are associated with a higher likelihood of complications are inadequate post-operative radiological appearance.
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