Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children

作     者：Henry Claireaux Richard Goodall Joshua Hill Elizabeth Wilson Philippa Coull Sebastian Green James Schuster-Bruce Diana Lim Joanna Miles Payam Tarassoli Claireaux Henry;Goodall Richard;Hill Joshua;Wilson Elizabeth;Coull Philippa;Green Sebastian;Schuster-Bruce James;Lim Diana;Miles Joanna;Tarassoli Payam

作者机构：University of BristolSenate HouseTyndall AveBristolBS8 1THUK Bristol Royal Hospital for ChildrenMaudlin StBristolBS2 8BJUK 

出 版 物：《Chinese Journal of Traumatology》 (中华创伤杂志（英文版）)

年 卷 期：2019年第22卷第5期

页      面：249-254页

核心收录：

学科分类：0403[教育学-体育学] 1002[医学-临床医学] 10[医学] 

基　　金：This research did not receive any specific grant from funding agencies in the public  commercial  or not-for-profit sectors 

主　　题：Fracture fixation Humerus Child Nerve injury Bone wires 

摘      要：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.Uncertainty 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 w让h GartlandⅡorⅢsupracondylar fractures at five hospitals in southwest 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 supracondylar fractures.We found significant variations in practice and compliance w让h the British Orthopaedic Association Standard for Trauma(BOAST)11 guidelines.