Abstract
Introduction: The preferred treatment for displaced supracondylar humeral fractures in children is closed reduction and percutaneous pinning. Cross-wiring techniques are biomechanically superior to parallel lateral wiring techniques. The purpose of this study was to review our experience with a novel cross wiring technique performed entirely from the lateral side. This avoids the potential for ulnar nerve injury in these difficult cases.
Patients and Methods: We collected all children with supracondylar fractures of the distal humerus who were manipulated and wired by one surgeon, using a lateral cross wiring technique. Patient demographics, mechanism of injury, fracture classification (Gartland’s classification) and associated neurovascular injuries were noted. At follow-up (12 weeks), range of motion and carrying angle were measured.
Results: Twenty patients were identified and reviewed. There were 8 female and 14 male patients, mean age 10 years (range 2–11). Two fractures were Type II, 12 were Type IIIA and 6 were Type IIIB. Three patients had signs of an anterior interosseous nerve injury and one patient had a brachial artery laceration.
All fractures were reduced, cross-wired from the lateral side, and rested in an above elbow slab. Wires were removed at 4 weeks.
At follow-up, all children had a full range of motion and the mean carrying angle was 17° (range: 15–20). All three patients with pre-operative nerve injuries had full recovery of nerve function.
Conclusions: Lateral cross wiring of supracondylar fractures represents a real option in the treatment of these injuries. It offers the biomechanical advantages of traditional cross-wiring without the risk of nerve injury.
The abstracts were prepared by Mr Ray Moran. Correspondence should be addressed to him at Irish Orthopaedic Associaton, Secretariat, c/o Cappagh National Orthopaedic Hospital, Finglas, Dublin 11.
