A comparison between percutaneous cross k wire and lateral k wires fixation in management of Type II.pptx

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1. Comparison of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures Presented by: Dr.Arvind Nagar Moderator: Dr.Amol Sakurkar PG1 Resident Assistant Professor Department of orthopaedics Department of orthopaedics CMCH,Bhopal CMCH,Bhopal

2. Introduction Supra- condylar humerus fractures (SCHF) are one of the most common injuries in childhood . A fall onto the outstretched hand is the typical mechanism of injury, and severity of these extension-type injuries can be classified according to the Wilkins-modified Gartland classification. By definition, the Gartland type I fracture is stable, with intact anterior and posterior cortex and minimal risk of displacement or angulation. In Gartland type II and III, various degrees of displacement and angulation are present

3. Classification Type I: non-displaced or minimally displaced (<2 mm) supracondylar fracture Type II: displaced (>2 mm) supracondylar fracture with an intact, yet hinged, posterior cortex Type III: displaced supracondylar fracture with no meaningful cortical contact Type IV: displaced; multidirectional instability due to an incompetent periosteal hinge, being unstable in both flexion and extension

4. Treatment Type I fractures are treated with cast. Type II fractures can be treated with close reduction (by flexing the distal fragment) and cast application or by Dunlop’s skeletal traction . Type III fractures need to be reduced by either close or open method and fixed by percutaneous pins as these types of fractures definitely have chance of malunion due to displacement.

5. AIM The aim of this systematic review was to investigate functional and radiographic outcome after crossed and lateral K-wire fixation for displaced extension-type SCHF, and complications related to the type of K-wire construction used.

6. METHODS AND MATERIALS Systematic Reviews and Meta-Analysis (PRISMA ) was performed from Studies concerning supracondylar humeral fractures in children in the following databases: MEDLINE (January 1966 – April 2015), Embase (January 1974 – April 2015), Web of Science (January 1988 – April 2015) and the Cochrane Library (to Issue 4, 2015 ) INCLUSION CRITERIA: Patients with both Gartland type II and III fractures The mean follow-up period ranged from eight to thirty weeks

7. SURGICAL TECHNIQUE Percutaneous k-wire fixation done by 2 methods: Cross k-wire fixation lateral k-wire fixation

8. ASSESSMENT OF OUTCOME: The primary outcomes of interest were : ( a) functional outcome classified according to the Flynn criteria or expressed as the range of motion, degree of maximal elbow flexion and/or extension and ( b) radiographic outcome expressed as the Baumann angle, change in Baumann angle, carrying angle, loss of carrying angle, change in humerocapitellar angle , and loss of reduction. The secondary outcomes were complications associated with surgical treatment, including iatrogenic ulnar nerve injury, infection, reoperation, compartment syndrome and Volkmann ischaemic fracture.

9. RESULTS:

10. DISCUSSION Many studies concerning surgical treatment of SCHF have been published. While these studies invariably report stable constructs using two or three K-wires, the ideal pin configuration is still controversial. Options for pin configuration include two lateral pins, two crossed pins, three lateral pins and three crossed pins. In this meta-analysis, no significant difference between the crossed and lateral pin configuration was found when comparing functional and radiographic outcomes. However, as expected, ulnar nerve injury occurred three times more often in patients treated with crossed pins.

11. CONCLUSION In this study, crossed and lateral entry pin fixation of displaced supraconylar humerus fracture result in similar construct stability and functional outcome. However, ulnar nerve injury was 3 times more likely to occur after crossed pins fixation compared to lateral entry pins. Although ulnar nerve injury was more likely in the crossed K-wire group, the overall incidence of this complication was very low.