COMPARISON OF TWO METHODS OF FIXATION OF SUPRACONDYLAR FRACTURES OF THE HUMERUS IN CHILDREN

ABSTRACT Objective: To compare the outcomes of the fixation of complete and displaced supracondylar humeral fractures in children with two different Kirschner wire configurations. Methods: The type of fixation was randomized to either crossed (19 cases), or two divergent lateral Kirschner wires (24 cases). The comparison was made six months later between the two treated groups and each group with the non-fractured elbow (clinical alignment, range of motion, Baumann angle, and lateral humeral capitellar angle). Results: 43 children were evaluated (65% boys) with a mean age of six years and five months. The carrying angle (p = 0.94), extension (p = 0.89), and the Flynn´s criteria (p = 0.56) were similar between the groups. The flexion was slightly smaller for the crossed wire group (p = 0.04), but similar to the uninjured side. The Baumann angle was not different between the two fixations (p = 0.79) and the contralateral side (p = 0.1). The lateral humeral capitellar angle was slightly greater for the lateral pinning (p = 0.08), but with no difference with the uninjured elbow (p = 0.62). No iatrogenic injuries were observed. Conclusion: Both fixations presented similar outcomes that did not significantly affect the carrying angle in relation to the non-fractured side. Level of evidence II, Therapeutic study - Investigating the results of treatment.

摘要 目的：比较两种不同克氏针（Kirschner wire）构型固定儿童完全移位型肱骨髁上骨折的临床疗效。方法：将固定方式随机分为交叉克氏针组（19例）与外侧发散双克氏针组（24例）。术后6个月对两组患者及各自的健侧肘关节进行对比评估，评估指标包括临床对线情况、肘关节活动范围、鲍曼角（Baumann angle）及肱骨小头外侧角（lateral humeral capitellar angle）。结果：共纳入43例患儿，其中男性占65%，平均年龄6岁5个月。两组间的提携角（p=0.94）、伸直活动度（p=0.89）及弗林标准（Flynn´s criteria，p=0.56）均无显著差异。交叉克氏针组的屈曲活动度略低于外侧组（p=0.04），但与健侧肘关节无显著差异。两种固定方式的鲍曼角无显著差异（p=0.79），且与健侧相比亦无统计学差异（p=0.1）。外侧穿针组的肱骨小头外侧角略大于交叉组（p=0.08），但与健侧肘关节无显著差异（p=0.62）。本研究未观察到医源性损伤。结论：两种固定方式的临床疗效相近，与健侧相比，肘关节提携角未受到显著不良影响。证据等级：Ⅱ级，治疗性研究——探讨治疗方案的疗效。