Background: Supracondylar fractures in children are common, accounting for 65% of all elbow fractures in children. In types II and III displaced supracondylar humeral fractures, closed reduction is difficult to achieve because of the thin bone between the coronoid and olecranon fossae as well as stripping of the periosteum. In addition, hyperflexion for maintenance of fracture reduction leads to swelling, compartment syndrome, and neurovascular compromise.
Objective: To evaluate the clinical and radiological outcome after closed reduction and pinning using a Kirschner wire inserted vertically through the olecranon and another inserted laterally for displaced supracondylar humeral fractures.
Patients and methods: A prospective case series, single Centre study conducted at Al-Azhar University Hospitals from June 2020 to May 2021. It included 20 patients with Gartland type III fracture who undergone for closed reduction and percutaneous pin fixation using two Kirschner wires, the first one was inserted vertically through the olecranon across the fracture into the metaphysis of the humerus and the second wire was inserted from the lateral column across the fracture at 30-40 degree to the opposite cortex of the humerus.
Results: Operative time ranged from 15- 30 minutes with a mean of 19.25 minutes. We counted the operative time after induction of anesthesia (including draping, reduction, wires insertion and splint application). Results were within normal range for all patients. The mean Baumann angle in the patients was 70.57 degree, and standard deviation was 3.01. Postoperatively, anteroposterior and lateral views were done, and wires were removed by 3 weeks if clinical and radiological evidence of early bone union was present and, if not, wires removal was postponded one week later. Thirteen patients (65%) had the wires removed by 3rd week, and 7 patients (35%), the wires were removed by 4th week with a mean of 3.35 week, and standard deviation of 0.49. Few complications occurred and all were tolerable with no effect on final outcome, and these were pin tract infection in 2 patients and loss of reduction.
Conclusion: Transolecranon and lateral Kirschner wires fixation was an effective option for displaced supracondylar humeral fractures in children.