Outcome of Lateral-Entry Versus Crossed K-Wire Fixation in Displaced Supracondylar Humerus Fractures in Children: A Prospective Comparative Study

Abstract

Background: Displaced supracondylar humerus fractures are the commonest operative injury of the paediatric elbow. Closed reduction and percutaneous K-wire fixation is the accepted standard, but the ideal pin configuration remains debated. Objective: To compare the radiological, functional and complication profiles of lateral-entry and crossed K-wire fixation in Gartland type II, III and IV supracondylar humerus fractures in children.

Methods: Forty children (3–12 years) with displaced supracondylar humerus fractures were prospectively randomised into a lateral-entry group (Group L, n=20) and a crossed group (Group C, n=20). All patients were followed up for a period of 9 months (mean 10.6 months). Outcome measures included Baumann's angle, carrying angle, Flynn's criteria and post-operative complications.

Results: Radiological and functional outcomes were comparable between the two groups (p > 0.05). Iatrogenic ulnar nerve palsy occurred in 3/20 (15%) children in the crossed group and none in the lateral group; the difference showed a strong clinical trend but did not reach statistical significance in this small sample (p = 0.23). Loss of reduction requiring re-manipulation occurred in 2/20 (10%) children in the lateral group and 1/20 (5%) in the crossed group (p = 1.00). Operative time and fluoroscopy exposure were marginally higher in the lateral group.

Conclusion: Both constructs produce equivalent radiological and functional outcomes. Lateral-entry pinning avoided iatrogenic ulnar nerve injury in this series and should be preferred, with a medial wire reserved for demonstrably unstable constructs and placed by a mini-open technique.