Supracondylar Humeral Fractures: An Audit of the Frequency of Bi-columnar Fixation and Intra-articular Wire Placement

Introduction For supracondylar humeral (SCH) fractures, biomechanical studies suggest the most stable wire configuration achieves bi-columnar fixation. Achieving medial column fixation using lateral-entry-only wires may require an intracapsular entry point. The aim of this study was to identify the rate of bi-columnar fixation achieved in our department when treating SCH fractures with percutaneous wire fixation. A secondary aim was to identify the rate of placement of an intra-articular wire. Further aims were to examine if failure to achieve bi-columnar fixation was associated with an increased loss of fixation and whether the placement of an intra-articular wire resulted in any cases of deep infection or septic arthritis. Material and methods All Gartland type 3 supracondylar humeral fractures, June 2014 to December 2016, were retrospectively identified. Intra-operative films were reviewed to determine bi-columnar fixation and the presence/absence of an intra-articular wire. Loss of reduction requiring revision and post-operative infections were determined from the electronic patient record. Results Of 49 supracondylar fractures identified, 42 were fixed with lateral-entry only wires (24 with two wires and 18 with three wires), and seven were fixed with medial/lateral cross wires (four with one lateral wire, two with two wires, and one with three wires). Bi-columnar fixation was achieved in 41/49 cases (84%). All cases where bi-columnar fixation was not achieved were fixed with lateral-entry-only wires. One out of 49 fractures (2%) required the revision of fixation at 10 days due to loss of reduction. In this case, the initial fixation was with two lateral-entry-only wires, without bi-columnar fixation. An intra-articular wire was present in 44 out of 49 cases (90%). One out of 49 cases (2%) had a superficial wound infection. There were no cases of deep infection or septic arthritis. Conclusion In our department, the rate of bi-columnar fixation was high and, in this group, no cases required revision fixation. One of eight cases judged to not have bi-columnar fixation initially, required revision due to loss of fixation. We contend that bi-columnar fixation generally achieves a stable wire configuration even using lateral-entry-only wires for SCH fractures. The rate of intra-articular wire placement was high; however, infection rates were low with no cases of septic arthritis.