A STUDY FOR CHANGING PRACTICES IN TREATING DISPLACED SUPRACONDYLAR FRACTURES TREATED BY PERCUTANEOUS KIRSCHNER WIRES

Abstract

Aim: To propose new guidelines in the management of supracondylar fractures treated by percutaneous Kirschner wires.

Subjects and Method: We audited 62 children with displaced, unstable supracondylar fractures of the humerus, which were fixed with Kirschner wire over a period of 2 years. The fractures were classified according to the Wilkins modification of the Gartland system. 10% were type II and 90% type III. The protocol followed was that all unstable fractures that required closed or open reduction must be stabilised with Kirschner wires of adequate thickness used in a crossed configuration and supplemented with back slab. They were then followed up mostly weekly, often with multiple check X-rays until 3 weeks, and for wire removal at 3 weeks. The parameters studied are level of surgeon, adequacy of intra operative reduction, re operation rate, adequacy of intra operative X-rays, out of hour operations, number of post operative X-rays, number of follow ups and any complications.

Results:

1. Two patients had re operation because of poor intra operative reduction which were performed by junior grade surgeon without supervision during out of hours.

2. No fracture had displaced at follow up when compared with the intra operative X-ray when properly reduced and wired.

3. One child had ulnar neuropraxia post operatively

4. One child had superficial infection, which settled with oral antibiotics.

Conclusions: Unnecessary radiation can be avoided by obtaining adequate intra operative X-rays and avoiding check X-ray as no fracture had displaced at follow up. New guidelines proposed: 1. Patients with no N-V complications can wait till the morning trauma list. 2. All intraoperative X-rays to be reviewed by consultants before discharging home. 3. 3 weeks appointment for wire removal can be set at one week clinic follow up with out X-ray.