Kirschner wires fixation alone or Kirschner wires fixation with tension band wiring in paediatric fractures of the lateral humeral condyle

Abstract

Purpose: Displaced lateral humeral condyle fractures in children are commonly fixed using Kirschner wires (K-wires). However, K-wire fixation alone is insufficient for early elbow range of motion (ROM) exercises. Comparatively, combined fixation with tension band wiring (TBW) converts distraction forces into compression forces, which provides more rigid fixation than K-wire fixation alone. Here, we retrospectively evaluated the clinical outcomes for patients with displaced lateral humeral condyle fractures treated with TBW or K-wires only.

Materials and methods: We identified children with lateral condyle fractures who had undergone surgery from April 2000 to March 2014. Nineteen patients were classified into 2 groups according to treatment: 10 patients were allocated to the TBW group (TBW and K-wires), and 9 patients to the K-wires group. The mean time between injury and surgery was 5.1 days and 5.1 days in the TBW and K-wires groups, respectively. Fractures were classified using Jacob's and Milch's classifications. We recorded postoperative complications, radiological and clinical evaluations, ROM, and Flynn's criteria.

Results: The mean follow-up time was 14.4 months and 5.9 months in the TBW and K-wires groups, respectively. The mean of bone union time was 38.6 days and 49.8 days in the TBW and K-wires groups, respectively. Patients in the K-wires group required a cast/splint for significantly longer than TBW patients (49.8 days vs. 35.8 days on average, respectively). Range of flexion was significantly decreased at the final follow-up in patients in the K-wires group.

Conclusions: TBW fixation is probably optimal procedure for displaced lateral humeral condyle fractures in children, as it can promote early active range of motion exercise.