Comparison of Pin Tract Infection Rate in Buried Versus Unburid Krischner Wires Fixation in the Management of Gartland Type III Supracondylar Fracture of Humerus in Children
Keywords:
: Buried wires, Fracture, Gartland Type III, Pin tract infection, SupracondylarAbstract
Objective: To evaluate the results of pin tract infection rate in buried versus unburied Kirshner wires fixation in the management of Gartland type III supracondylar fracture of humerus in children.
Methods: This randomized control trials study was conducted in the Department of Orthopedics and Trauma, Medical Teaching Institute Lady Reading Hospital, Peshawar Pakistan from December 2020 to June 2021 on 62 (31 in each groups) patient having age range of less than 12 years of either gender having closed fracture of less than two days old with no neurovascular injury. All the patients were observed to compare pin tract infection rate in buried versus unburied Kirshner wires fixation in the management of Gartland type III supracondylar fracture of humerus in children. Sampling technique was non-probability consecutive sampling.
Results: In this study age distribution among 62 patients was analyzed as n= 2 -4 Years 17(27.4%) 4-6 Years 14(22.6%) 6- 9 Years11(17.7%) 9-12 Years 20(32.3%). Mean age was 7.1 Years with SD ±2.87 (Gender wise Distribution among 62 Patients were analyzed as Male were 31(50.0%) and female were 31(50.0%) Distribution of duration of disease among 62 patients were analyzed as n= 1-2 weeks was 47(75.8%) and 3-4 weeks was 15(24.2%)BMI classification among 2 patients were analyzed as n= Below 18.5 Underweight was 25(40.3%) 18.5–24.9 Normal weight was 10(16.1%) 25.0–29.9 Pre-obesity was 17(27.4%) and 30.0–34.9 Obesity class was 9(14.5%)Distribution Pin tract Infection after 4 weeks among the groups were analyzed as n= Infection rate among Group A (K-Wires buried) was 4(12.9%) and Group B (K-Wires Unburied) 9(29.%)
Conclusion: We believe that closed reduction and buried percutaneous lateral pinning is an efficient, reliable and safe method.
References
Ilyas AM, Jupiter JB. Treatment of distal humerus fractures. Acta Chir Orthop Traumatol Cech. 2008 Feb. 75 (1):6-15. [Medline].
Pollock JW, Faber KJ, Athwal GS. Distal humerus fractures. Orthop Clin North Am. 2008 Apr. 39 (2):187-200, vi. [Medline].
Wong AS, Baratz ME. Elbow fractures: distal humerus. J Hand Surg Am. 2009 Jan. 34 (1):176-90. [Medline].
Ihsanullah, Inam M , Khalid, Shabir M, Ali MA . Outcome of Supracondylar Fractures of Humerus in children treated with Dorgan’s Surgical Technique. J Pak Orthop Assoc.2020;31(4):153–156.
Riseborough EJ, Radin EL. Intercondylar T fractures of the humerus in the adult. A comparison of operative and non-operative treatment in twenty-nine cases. J Bone Joint Surg Am. 1969 Jan. 51 (1):130-41. [Medline].
Milch H. Fractures and fracture-dislocation of the humeral condyles. J Trauma. 1964. 4:592-607.
Farley FA, Patel P, Craig CL, Blakemore LC, Hensinger RN, Zhang L, et al. Paediatric supracondylar humerus fractures: treatment by type of orthopaedic surgeon. J Child Orthop. 2008 Mar. 2 (2):91-5. [Medline]. [Full Text].
Pescatori E, Memeo A, Brivio A, Trapletti A, Camurri S, Pedretti L, et al. Supracondylar humerus fractures in children: a comparison of experiences. J Pediatr Orthop B. 2012 Nov. 21 (6):505-13. [Medline].
Micheloni GM, Novi M, Leigheb M, Giorgini A, Porcellini G, Tarallo L. Supracondylar fractures in children: management and treatment. Acta Biomed. 2021 Jul 26;92(S3):e2021015. doi: 10.23750/abm.v92iS3.11725. PMID: 34313666; PMCID: PMC8420822.
Silva M, Pandarinath R, Farng E, Park S, Caneda C, Fong YJ, et al. Inter- and intra-observer reliability of the Baumann angle of the humerus in children with supracondylar humeral fractures. Int Orthop. 2010 Apr. 34 (4):553-7. [Medline].
Lee SS, Mahar AT, Miesen D, Newton PO. Displaced paediatric supracondylar humerus fractures: biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop. 2002 Jul-Aug. 22 (4):440-3. [Medline].
Zionts LE, McKellop HA, Hathaway R. Torsional strength of pin configurations used to fix Supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1994;76:253–6. [PubMed] [Google Scholar]
Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am. 2001 May. 83-A (5):735-40. [Medline].
Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am. 2004 Apr. 86-A (4):702-7. [Medline].
Athwal GS, Goetz TJ, Pollock JW, Faber KJ. Prosthetic replacement for distal humerus fractures. Orthop Clin North Am. 2008 Apr. 39 (2):201-12, vi. [Medline].
Hill CE, Cooke S. Common Paediatric Elbow Injuries. Closed Orthop J. 2017. 11:1380-1393. [Medline].
Iyer RS, Thapa MM, Khanna PC, Chew FS. Paediatric bone imaging: imaging elbow trauma in children--a review of acute and chronic injuries. AJR Am J Roentgenol. 2012 May. 198 (5):1053-68. [Medline].
Lyons J, Ashley E, Hoffer MM. Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop. 1998;18:43–45. [PubMed] [Google Scholar]
Rasool MN. Ulnar nerve injury after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop 1998;18(5):686-690..
Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am. 2008 May. 90 (5):1121-32. [Medline].
Leitch KK, Kay RM, Femino JD, Tolo VT, Storer SK, Skaggs DL. Treatment of multidirectional unstable supracondylar humeral fractures in children. A modified Gartland type-IV fracture. J Bone Joint Surg Am. 2006 May. 88 (5):980-5. [Medline].
Shaath K. Lateral condyle fracture - paediatric. Orthobullets.Available at http://www.orthobullets.com/pediatrics/4009/lateral-condyle- fracture--pediatric. Accessed: July 18, 2018.
Lampignano J, Kendrick LE. Bontrager's Textbook of Radiographic Positioning and Related Anatomy. 9th ed. St Louis: Elsevier; 2018.
Pirone AM, Graham HK, Krajbich JI. Management of displaced extension-type Supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1988;70:641–50. [PubMed] [Google Scholar]
Lee KM, Chung CY, Gwon DK, Sung KH, Kim TW, Choi IH, et al. Medial and lateral crossed pinning versus lateral pinning for Supracondylar fractures of the humerus in children: Decision analysis. J Pediatr Orthop. 2012;32:131–8. [PubMed] [Google Scholar]
Dua A, Eachempati K, Malhotra R, Sharma L, Gidaganti M. Closed reduction and percutaneous pinning of displaced Supracondylar fractures of humerus in children with delayed presentation. Chin J Traumatol. 2011;14:14–9. [PubMed] [Google Scholar]
Erpelding JM, Mailander A, High R, Mormino MA, Fehringer EV. Outcome following distal humeral fracture fixation with an extensor mechanism-on approach. J Bone Joint Surg Am. 2012;94:548–53. [PubMed] [Google Scholar]
Woratanarat P, Angsanuntsukh C, Rattanasiri S, Attia J, Woratanarat T, Thakkinstian A. Meta-analysis of pinning in Supracondylar fracture of the humerus in children. J Orthop Trauma. 2012;26:48–53. [PubMed] [Google Scholar]
















