A COMPARATIVE STUDY OF INCIDENCE OF IATROGENIC ULNAR NERVE INJURIES IN TWO DIFFERENT TECHNIQUES OF CROSS KIRSCHNER WIRE CONFIGURATION FOR FIXATION OF PAEDIATIC SUPRACONDYLAR FRACTURES OF HUMERUS

Abstract

Abstract

Objective:  The objective of this study was to com-pare the incidence of iatrogenic ulnar nerve injuries in two different techniques of cross Kirschner wire configuration for the fixation of paediatric supracon-dylar fractures of humerus.

Methodology:  Forty patients attending Accident and Emergency Department of The Children's Hospital and Institute of Child Health, Lahore, with supracon-dylar fracture of humerus were studied from September 2014 to March 2015 to compare the incidence of iatrogenic ulnar nerve injuries in two techniques of cross Kirschner wire configuration for the fixation of supracondylar fractures of humerus. These patients were divided in group A and group B. Each group consisted of 20 patients. The fracture of patients in group A was fixed with two lateral cross Kirschner wires configuration and fracture of patients in group B was fixed with mediolateral cross Kirschner wires con-figuration. All the operations were performed by same team of Paediatric orthopaedic surgeons. Technique of Kirschner wire fixation of the fracture was allocated to the patients randomly. Informed consent was taken from parents of the patient. Detailed history of the patient was taken and thorough clinical examination including evaluation of neuromuscular status of the injured limb was done and recorded. Complete blood counts and urine analysis were done. Preoperative antibiotics were administered intravenously. In general anaesthesia, closed reduction of the fracture was done under C arm x-ray image intensifier control, fracture was held reduced manually and fixed with percuta-neous Kirschner wires according to the fixation techni-que allocated to the patient. The Kirschner wires were bent, cut, buried under the skin, aseptic dressing and plaster back slab was applied. After recovery from general anaesthesia neurovascular status of the limb was re-evaluated and check x-rays of the elbow were done. Next day, the patient was discharged from the hospital and examined clinically and radiologically at 3 weeks, 6 weeks and 12 weeks.

Results:  In this comparative study of incidence of iatrogenic ulnar nerve injuries in two different techni-ques of cross Kirschner wire configuration for fixation of paediatric supracondylar fractures of humerus, the peak incidence of the fractures was between the age of 5 - 7 years. There were 28 (70%) males and 12 (30%) were females with male to female ratio of 2.3:1. Nine (23%) patients sustained injury at home, 7 (17%) pat-ients during cycling, 22 (55%) patients during playing and 2 (5%) fell from height. Right side was fractured in 14 (35%) patients and left side was fractured in 26 (65%) patients. One patient (5%) had flexion type of fracture and 39 patients (95%) had extension type of fracture.  According to Gartland classification 5 (13%) had type II and 34 (87%) had type III fractures. In gro-up A, in which the fracture was fixed with two lateral cross Kirschner wire configuration none of the patients had iatrogenic ulnar nerve injury. In group B, 1 (5%) patient in which fracture was fixed with mediolateral cross Kirschner wire configuration, an iatrogenic ulnar nerve injury was observed which completely recove-red in 6 weeks with physiotherapy.

Conclusion:  Techniques of two lateral cross Kirs-chner wire configuration and mediolateral cross Kirs-chner wire configuration are equally effective for fix-ation of paediatric supracondylar fracture of humerus. But mediolateral cross configuration technique can cause iatrogenic ulnar nerve injury. Therefore, it is concluded that two lateral cross Kirschner wire techni-que is a safe method for fixation of paediatric supra-condylar fractures of humerus in terms of iatrogenic ulnar nerve injury.

Keywords:  Supracondylar fracture, closed percutane-ous K wires, lateral cross and mediolateral cross.