Kirschner wire reconstruction of medial and lateral column periosteal hinge in the treatment of multidirectionally unstable supracondylar fracture of the humerus in children
Authors: Ma Hailong , Sun Jun , Zhang Sicheng , Sun Xiwei , Liu Fang , Hua Zhongtuo 
Published: September 2023

Abstract
Background Multidirectionally unstable supracondylar fracture of the humerus often requires open reduction. We present a simple technique for closed reduction using a Kirschner wire reconstruction-based treatment of internal and lateral column periosteal hinge for the treatment of multidirectionally unstable supracondylar fractures of the humerus in children.
Methods A retrospective cohort study was conducted to analyse the clinical data of 43 patients (27 male and 16 female; mean age: 3–13 [7.0±2.5] years old) with multidirectionally unstable supracondylar fractures of the humerus treated in our Hospital from August 2020 to August 2022. They were divided into two groups according to the development of surgical techniques in our hospital. From September 2021 to August 2022,Twenty-one cases were treated with Kirschner wire reconstruction of the internal and lateral columns periosteum hinge assisted by closed reduction and Kirschner wire internal fixation (study group), and from August 2020 to August 2021, Twenty-two cases were treated with closed reduction and Kirschner wire internal fixation (control group). The operation time, intraoperative fluoroscopy times, percentage of patients who underwent open reduction after failure of closed reduction (incision rate), fracture healing time, Baumann Angle, and Flynn score of elbow function at the last follow-up were compared between the two groups. Complications such as infection and irritation of Kirschner wire tail were observed in the two groups 2 months after the operation.
Results All patients were followed-up for 4–18 months ([8.6±4.2] months). The average operation time of the control group was 84.5 min (range: 51.0–111.0 min), which was significantly longer than that of the study group 34.4 min (range: 25.5–41.5 min) (P<0.05). The number of intraoperative fluoroscopy (30.0±8.9) in the control group was significantly higher than that in the study group (16.4±6.2) (P<0.05). The incision rate of the control group was 18% while that of thestudy group was 0 (P<0.05). The fracture healing time of the control group and the study group were 4.6±1.1 weeks and 4.3±0.7 weeks, respectively (P>0.05). Baumann Angle was 71.0±2.1° in the control group and 71.0±2.6° in the study group (P>0.05). According to Flynn score, the excellent and good rates of the elbow joint in the control group was 86.3%(19/21), including 17 excellent, 2 good, 3 fair, and 0 bad cases. The excellent and good rate of the elbow joint in the study group was 95.2%(20/21), including 18 excellent, 2 good, 1 fair, and 0 bad cases (P>0.05). No infection or Kirschner wire tail irritation occurred in the two groups during the 2-month follow-up.
ConclusionReconstruction of internal and lateral periosteal hinges with Kirscher wire has similar effects to closed reduction and Kirschner wire fixation in the treatment of multidirectionally unstable supracondylar fractures of the humerus in children, but it can shorten the operation time, reduce intraoperative fluoroscopy times and incision rate.