The Outcome of Placing the Medial K-wire First and Then the Lateral K-wire in Treating Supracondylar Humerus Fractures in Children Treated by Closed Reduction

Background Displaced Gartland type III and IV supracondylar fractures are difficult to reduce and invariably require closed pining. After closed reduction, taking the anteroposterior (AP) view does not present any problem but when the elbow is placed in flexion and the limb is rotated internally to take a lateral view, the reduction is invariably lost. However, the reduction stays when the arm is rotated outwards, keeping the medial condyle up. This stimulates the idea of whether the medial pin can be placed first and then the two lateral pins to stabilize the fracture. It is very frustrating for young orthopedic surgeons to see reduction getting lost during internal rotation after first doing lateral pinning. There is no clear guideline on which side should be fixed first. Hypothesis We hypothesized that placing the medial pin first maintains the reduction and facilitates the subsequent placing of lateral pins without the loss of reduction. Materials and methods A total of 170 children with displaced supracondylar humerus fractures were included in the study. A total of 120 children were grouped in the medial wire first group, and 50 were placed in the lateral wire first group, which was the control group. The mean age of the children was 7.5 years (range 2-13 years). The gender ratio (M: F) was 5:3; the left elbow was involved in 68% of the injuries, whereas the right elbow was involved in 32% of the injuries. All 170 children had an extension-type injury, with 91 (53.5%) fractures being Gartland type III and 79 (46.45%) fractures being type IV. Results Results were recorded as per Flynn's criteria. At the end of two years of follow-up, the children in the medial wire first group 117 (97.5%) showed excellent results and three (2.5%) children showed good results, whereas, in the lateral wire first group, 48 (96%) children showed excellent results and two (3.8%) children showed good results. There was a significant difference in the mean surgical time of 20.11±15.43 minutes in the medial wire first group vs 41.23±19.65 minutes in the lateral first group (p = 0.0021). None of the children developed permanent ulnar nerve palsy. Conclusions Placing the medial K-wire first rather than the conventional placing of the lateral wire first helps in maintaining the reduction and allows for the subsequent placement of lateral K-wires without losing the reduction, thus minimizing fixation time and producing good results.