K-wire fixation versus Slongo's external fixation for the treatment of Gartland Ⅲ b supra-condylar humeral fractures in children
Objective To compare the clinical efficacy of K-wire fixation and Slongo's external fixation for the treatment of Gartland Ⅲ b supracondylar humeral fractures in children.Methods A retrospective analysis was conducted on the clinical data of 95 children with Gartland Ⅲ b supracondylar humeral fractures,who were admitted to our hospital from Jan.2021 to Jun.2022.There were 61 males and 34 females aged 4-12 years,mean 6.1 years.The injury involved the left side in 70 cases and right side in 25 cases,with 86 due to falls and 9 to road traffic acci-dents.The BMI was 13.2-18.3(mean 15.1)kg/m2 and the time interval from injury to surgery was 2-19(mean 10.3)h.Patients were divided into K-wire group(n=65)and external fixation group(n=30)according to the sur-gical methods.The operation time,rate of open reduction,frequency of fluoroscopy and postoperative complications were recorded and compared between the two groups.The Flynn's criteria were adopted to evaluate the treatment outcomes.Results Compared with the K-wire group,the external fixation group showed a much shorter operation time(min,27.1±5.3 vs.40.6±3.9)and less frequency of fluoroscopy(13.9±4.0 vs.26.1±2.5,both P＜0.05);while the rate of open reduction revealed no significant difference(9.2％vs.16.7％).None of the children had needle tract deep infection,but the rate of superficial infection was much higher in the external fixator group(16.7％)than in the K-wire group(3.1％,P＜0.05).All the fixation devices(K-wire or external fixator)were re-moved at 4 weeks after surgery when the Baumann angle was 76.9°±3.3° in the K-wire group and 78.2°±3.4° in the external fixator group,which revealed no significant difference between two groups but lower than that of normal children(average 81°).Further comparison between K-wire group and external fixation group showed no significant difference in the rate of sagittal plane deformity(7.7％vs.6.7％),6-month elbow joint mobility(145.1°±6.3° vs.143.6°±6.0°)and good-to-excellent rate by Flynn elbow joint function(96.1％±3.9％vs.95.9％±3.9％,all P＞0.05).Conclusion Compared with K-wire fixation,Slongo's external fixation for the treatment of Gartland Ⅲ b supracondylar humeral fractures in children can shorten the operation time,reduce the frequency of fluoroscopy,but with a higher risk of superficial needle tract infection.Therefore,it is better to adopt the appropriate fixation method based on the actual situation of the children.
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