Introduction

Paediatric supracondylar humeral fractures are the most common fracture, accounting for 50–60% of fractures in the elbow region and 30% of all extremity fractures [1]. In the treatment of non-displaced humeral fractures conservative methods are used, while in displaced cases, closed or open reduction and percutaneous Kirschner-wire (K-wire) fixation may be used [2]. Most author advocates the need for early postoperative clinical and radiographic follow-up [3,4,5]. In central India where the rural population is predominant it is practically impossible for them to come for weekly follow-up X-rays, therefore this study was undertaken with purpose of determining the necessity of postoperative x rays after K-wire fixation

Materials and Methods

123 paediatric patients who had undergone treatment for supracondylar humeral fracture from November 2012 to January 2016 were evaluated. Exclusion criteria were; 1) Any neurological and vascular injuries, 2) Ipsilateral arm or forearm fractures, 3) open fractures, 4) Patients treated by other methods or whose medical records were incomplete, and 5) Fractures having intra-articular extension.

103 patients who were able to attend up to the final examination were included in the study. Fractures were classified according to Gartland’s system. Operative fixation was performed by three different surgeons. The patients were operated upon within 48 hours after the trauma. Closed reduction was performed on all patients, the adequacy of which was assessed by C-arm fluoroscopy. Then k-wire fixation was done with all aseptic precaution.

More than ninety percent cases fracture were treated with percutaneous two parallel lateral entry k-wires. They were considered stable only if near anatomic configuration was obtained and fracture remains stable intraoperative range of motion under continuous mode of C arm machine. After fixation K-wires were left out of the skin after bending for subsequent removal. Patients were placed in an above elbow slab postoperatively. There was postoperative assessment for any complications and treated according to guidelines. The patients were discharged after twenty four hours after completion of surgery.

There has been no uniformity of postoperative follow up of these patients clinically as well as radiographically to determine healing, alignment, and appropriate time for k-wire and cast removal. Most author advocate procuring serial radiographs to identify changes in fracture alignment and k-wire position [3,4,5]. Very few studies are there regarding true requirement of radiological follow-up in the early postoperative period. In central India rural population it is practically impossible to obtain weekly follow-up moreover it is time consuming as well as increases economic burden over parents. So this study was panned to examine whether these observed radiographic changes provoked a change in clinical care or in final patient outcome.

Ponce and colleagues reviewed hundred and four supracondylar humerus fractures to evaluate the need for early follow-up and in these patients they found no increased rate of complications in those who had late radiographic follow-up [6].

Our series demonstrated a 2.9% rate of k-wire back out or change in fracture alignment. In all cases, the change in fracture alignment was <2 mm. None of these patients showed clinical evidence of postoperative neuropraxia or cubitus varus at final follow-up.

K-wire-site infections are another identified complication of percutaneous k-wire fixation, with published rates from 2% to 7% [7]. In our series, k-wire-site infections were seen in five patients (4.8%). All of these infections were superficial and resolved with a short course of oral antibiotics.

Compartment syndrome was diagnosed in one patients in the early postoperative period. Neither of these patients was observed to have neurological deficits or loss of fixation. According to Karamitopoulos et al if stability of pin construct is confirmed at surgery, mild alignment changes and pin migration observed in postoperative radiographs after pinning of supracondylar humerus fractures have little effect on clinical management parameters or long term sequelae [8], our study had similar results.

Within the obtained results, complications, and limitations of the present study, delaying postoperative X-rays can be considered without significant risk of complication until the time of expected k-wire removal provided that adequate intraoperative radiographic stability was obtained. If stability of k-wire construct is confirmed at surgery, mild alignment changes and k-wire migration observed in postoperative radiographs after k-wiring of supracondylar humerus fractures have little effect on clinical management parameters or long term complication.