The bone & joint journal · 2026
Management of displaced supracondylar fractures of the humerus using lateral versus crossed Kirschner wires: a prospective randomized controlled clinical trial.
СтатьяРандомизированное исследованиеEquivalence TrialСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Dobbe Ashlee, Schaeffer Emily K, Baraza Njalalle, Miyanji Firoz, Alvarez Christine, Cooper Anthony P, Reilly Chris W, Mulpuri Kishore
Аннотация
AIMS: We sought to evaluate whether loss of reduction in lateral Kirschner (K)-wiring is noninferior to crossed K-wiring in closed reduction and percutaneous pinning of Type III supracondylar humerus fractures.
METHODS: A prospective, randomized, non-inferiority trial was conducted. Emergency department patients aged three to seven years with Type III supracondylar humerus fractures were invited to participate with informed consent. Block randomization allocated patients into one of two pin configuration groups (lateral or crossed). Surgical technique and postoperative management were standardized between groups. All patients were treated with above-elbow casts, but no strict standardized protocol was applied. The primary outcome was loss of reduction, measured from Baumann's angle on radiographs taken postoperatively and at K-wire removal. Secondary outcomes included humerocapitellar angle and iatrogenic ulnar nerve injury. Data were analyzed using an independent-samples t-test.
RESULTS: A total of 55 patients were enrolled. Of these, 22 were allocated to lateral pinning (40%) and 29 to crossed pinning (53%). Six (five crossed, one lateral) received a third wire in the operating theatre. Four were excluded: one did not return for radiography at pin removal, one was not randomized, and two did not provide assent. There was no significant difference between groups in change in Baumann's angle during pin removal (mean difference -0.7° (95% CI -2.7 to 1.3)). Two crossed-group patients developed postoperative iatrogenic ulnar nerve injuries.
CONCLUSION: Closed reduction and percutaneous pinning using lateral K-wiring was not inferior to crossed K-wiring in managing this cohort of Type III supracondylar humerus fractures in children aged three to seven years, suggesting this approach as an option to reduce iatrogenic ulnar nerve injury risk. However, lack of a patient-reported outcome measure and economic evaluation, coupled with randomization after reduction, a narrow age range, and low recruitment rate limit the generalizability of these findings and may have introduced bias.
METHODS: A prospective, randomized, non-inferiority trial was conducted. Emergency department patients aged three to seven years with Type III supracondylar humerus fractures were invited to participate with informed consent. Block randomization allocated patients into one of two pin configuration groups (lateral or crossed). Surgical technique and postoperative management were standardized between groups. All patients were treated with above-elbow casts, but no strict standardized protocol was applied. The primary outcome was loss of reduction, measured from Baumann's angle on radiographs taken postoperatively and at K-wire removal. Secondary outcomes included humerocapitellar angle and iatrogenic ulnar nerve injury. Data were analyzed using an independent-samples t-test.
RESULTS: A total of 55 patients were enrolled. Of these, 22 were allocated to lateral pinning (40%) and 29 to crossed pinning (53%). Six (five crossed, one lateral) received a third wire in the operating theatre. Four were excluded: one did not return for radiography at pin removal, one was not randomized, and two did not provide assent. There was no significant difference between groups in change in Baumann's angle during pin removal (mean difference -0.7° (95% CI -2.7 to 1.3)). Two crossed-group patients developed postoperative iatrogenic ulnar nerve injuries.
CONCLUSION: Closed reduction and percutaneous pinning using lateral K-wiring was not inferior to crossed K-wiring in managing this cohort of Type III supracondylar humerus fractures in children aged three to seven years, suggesting this approach as an option to reduce iatrogenic ulnar nerve injury risk. However, lack of a patient-reported outcome measure and economic evaluation, coupled with randomization after reduction, a narrow age range, and low recruitment rate limit the generalizability of these findings and may have introduced bias.