Three-wire technique for irreducible extension type Supracondylar humeral fracture in children

Irreducible extension type supracondylar humeral fracture [ESCHF] accounts for 3-15% of cases and often requires open reduction, which carries the risk of complications. This study describes and reports the outcomes of the three-wire technique for treating irreducible ESCHF.

Twenty patients with irreducible ESCHF (8 girls and 12 boys) underwent closed reduction and percutaneous pinning using the three-wire technique. We inserted two K-wires in an unreduced position in the distal fragment and one proximal wire just above the olecranon fossa and used these three wires for manipulation and correction of sagittal, coronal, and rotational deformities at the fracture site.

All the fractures achieved acceptable closed reduction, with a mean operation time of 32.65 min. Radiological assessments showed favorable outcomes: the mean Baumann angle was 70.05 ± 1.70 degrees, the average carrying angle was 12.95 degrees, and the anterior humeral line dissected the capitellum at the middle third in 16 patients and at the anterior third in 4 patients. The complications included mild pin tract infections in five patients, all of which resolved within one week after K-wire removal.

The three-wire technique is effective for managing irreducible ESCHF, providing good outcomes while avoiding the risks associated with open reduction.