Henry Claireaux,Richard Goodall,Joshua Hill,Elizabeth Wilson,Philippa Coull,Sebastian Green,James Schuster-Bruce,Diana Lim,Joanna Miles,Payam Tarassoli.[J].Chin J Traumatol,2019,22(5):249-254. [doi]
Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children
  
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KeyWord: Fracture fixationHumerusChildNerve injuryBone wires
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Author NameAffiliation
Henry Claireaux University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK 
Richard Goodall University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK 
Joshua Hill Bristol Royal Hospital for Children, Maudlin St, Bristol, BS2 8BJ, UK 
Elizabeth Wilson University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK 
Philippa Coull University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK 
Sebastian Green University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK 
James Schuster-Bruce University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK 
Diana Lim University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK 
Joanna Miles University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK 
Payam Tarassoli University of Bristol, Senate House, Tyndall Ave, Bristol, BS8 1TH, UK； Bristol Royal Hospital for Children, Maudlin St, Bristol, BS2 8BJ, UK 
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Abstract:
      Purpose: Supracondylar fractures of the humerus cause significant morbidity in children. Nerve damage and loss of fracture reduction are common recognised complications in patients with this injury. Un certainty surrounds the optimal Kirschner wire configuration and diameter for closed reduction and pinning of these fractures. This study describes current practice and examined the association between wire configuration or diameter and outcomes (clinical and radiological) in the operative management of paediatric supracondylar fractures. Methods: Children presenting with Gartland II or III supracondylar fractures at five hospitals in south west England were eligible for inclusion. Collaborators scrutinised paper and electronic case notes. Outcome measures were maintenance of reduction and iatrogenic nerve injury. Results: Altogether 209 patients were eligible for inclusion: 15.7% had a documented neurological deficit at presentation; 3.9% who were neurologically intact at presentation sustained a new deficit caused by treatment and 13.4% experienced a clinically significant loss of reduction following fixation. Maintenance of reduction was significantly better in patients treated specifically with crossed 3 Kirschner wire configuration compared to all other configurations. The incidence of iatrogenic nerve injury was not significantly different between groups treated with different wire configurations. Conclusion: We present a large multicentre cohort study showing that crossed 3 Kirschner wires are associated with better maintenance of reduction than crossed 2 or lateral entry wires. Greater numbers would be required to properly investigate nerve injury relating to operative management of supra condylar fractures. We found significant variations in practice and compliance with the British Ortho paedic Association Standard for Trauma (BOAST) 11 guidelines.
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