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Comparing exposed and buried Kirschner wires in fixation for pediatric supracondylar humerus fractures: A propensity
Seigo Suganuma1, Kaoru Tada2, Shingo Takagawa1
1Department of Orthopaedic Surgery, 37076Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Insights
Exposed Kirschner wires (K-wires) in pediatric humerus fractures showed more backing out, while buried K-wires led to increased outpatient visits and longer hospital stays. This study compares outcomes for both fixation methods in pediatric supracondylar humerus fractures.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Pediatric supracondylar humerus fractures are common injuries requiring surgical fixation.
- Kirschner wires (K-wires) are frequently used for stabilization, with options for exposed or buried placement.
- The optimal K-wire technique for pediatric fractures remains a subject of clinical debate.
Purpose of the Study:
- To compare the clinical and radiographic outcomes of exposed versus buried Kirschner wires (K-wires) for treating pediatric supracondylar humerus fractures.
- To evaluate differences in complication rates, patient follow-up, and hospitalization duration between the two K-wire fixation methods.
- To assess the impact of K-wire placement on fracture reduction and stability.
Main Methods:
- A retrospective study analyzed patients undergoing K-wire fixation for supracondylar humerus fractures between 2007 and 2021.
- Data collected included patient demographics, fracture patterns, K-wire type (exposed vs. buried), operative details, and postoperative outcomes.
- Propensity score matching was employed to create comparable groups for analysis of complications, outpatient visits, and hospitalization length.
Main Results:
- After propensity score matching (43 pairs), exposed K-wires showed significantly more backing out (p < 0.01), while buried K-wires were associated with more skin irritation.
- The buried K-wire group experienced significantly more outpatient visits (p < 0.01) and longer total hospitalization durations (p < 0.01).
- No significant differences were observed in other complications, loss of reduction, or radiographic parameters like Baumann's angle and tilting angle between the groups.
Conclusions:
- While exposed K-wires present a risk of backing out, buried K-wires lead to increased healthcare utilization and parental burden due to more outpatient visits and longer hospital stays.
- The choice between exposed and buried K-wires involves balancing risks of mechanical complications against those of increased healthcare resource utilization.
- Further research may explore patient-reported outcome measures to fully elucidate the long-term implications of each K-wire technique.
Purpose:
To thoroughly compare the outcomes between exposed and buried Kirschner wires (K-wires) in fixation for pediatric supracondylar humerus fractures.
Methods:
We examined patients who underwent surgery at our institution between January 2007 and June 2021. We investigated their age, sex, fracture pattern, number of K-wires used, whether they were exposed or buried, operative time, postoperative complications, number of outpatient visits, duration from surgery to K-wire removal, total length of hospitalization, and perioperative radiographic parameters. After propensity score matching, intergroup comparisons were performed to assess the differences in postoperative complication rate, number of outpatient visits, duration from surgery to K-wire removal, total length of hospitalization, and loss of reduction.
Results:
Propensity score matching resulted in 43 pairs in both groups. Although more patients complained of skin irritation in the buried K-wire group, there was more backing out of the K-wire in the exposed K-wire group (p < 0.01). There were no significant differences in other complications. There were more outpatient visits in the buried K-wire group (p < 0.01). The duration from surgery to K-wire removal and the total length of hospitalization were significantly longer in the buried K-wire group (p < 0.01). There was no significant difference in the loss of Baumann's angle (p = 0.61), tilting angle (p = 0.48), or the development of rotation (p > 0.99) between groups.
Conclusion:
More outpatient visits and longer lengths of hospitalization in the buried K-wire group may lead to increased costs and burden on parents.
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