Closed reduction and percutaneous pinning with three Kirschner wires in children with type III displaced supracondylar fractures of the humerus

Objectives: We evaluated the results of closed reduction and percutaneous pinning in the treatment of displaced supra- condylar fractures of the humerus in children. Methods: Sixty-one children (41 boys, 20 girls; mean age 7.6 years; range 2 to 13 years) were treated for type III displaced supracondylar fractures of the humerus within the first six hours after trauma. Initial neurologic examinations were normal. Treatment included closed reduction followed by percutaneous pinning with two lateral and one medial K-wires, the last being placed during decreased (80 to 90 degrees) elbow flexion. The ulnar nerve was examined intraoperatively, at the time of dis¬charge, at the end of two weeks, and in the third and six months. On final examinations, the range of motion and carrying angles of both elbows were measured with a goniometer and antero- posterior and lateral radiograms of the affected elbows were examined. The results were evaluated using the clinical scoring system developed by Flynn et al. The mean hospital stay was 3.4 days (range 1 to 10 days) and the mean follow-up was 28.9 months (range 17 to 53 months). Results: Iatrogenic ulnar nerve injury occurred in two patients (3.3%), which showed complete clinical improve¬ment in three months. Union was achieved in all the patients. Superficial pin tract infections were seen in four patients (6.6%); and cubitus varus (1.6%) and myositis ossificans in two patients, respectively. Deep infection or compartment syndrome were not encountered. The results were excellent in 49 (80.3%), good in seven (11.5%), fair in two (3.3%), and poor in three patients (5%). Conclusion: Closed reduction and percutaneous pinning with three K-wires is an efficacious and safe procedure with a low complication rate in the treatment of type III displaced supra- condylar fractures of the humerus.