Long-term comparative study of internal fixation with Kirschner wires or cannulated screws for displaced medial epicondyle fractures of the humerus in children: A 10-year follow-up of 42 cases

BACKGROUND: The rationale behind the decision-making on which type of fixation to use in displaced medial epicondyle fractures is not well elucidated. This study aims to compare the long-term clinical and radiographic outcomes of internal fixation with either Kirschner wires (K-wires) or cannulated screws in children with displaced medial epicondyle fractures.
METHODS: In this study, 42 consecutive children who underwent surgical treatment for medial epicondyle fractures displaced more than 5 mm were categorized into two groups as follows: group A, 22 children undergoing fixation with K-wires and group B, 20 children undergoing fixation with a screw. The mean age was nine (median, 10.5; range, 6–14) years in group A and 15 (16, 10–17) in group B. The overall follow-up was 10 (median, 10; range, 5–15) years. To assess patients’ clinical outcomes, the Mayo Elbow Performance Scores (MEPS) were used in addition to the elbow range of motion (ROM) at the last follow-up. During the radiographic assessment, possible deformities secondary to the epicondyle fracture were examined on final follow-up radiographs.
RESULTS: The main MEPS were 95 (median, 95; range, 85–100) and 93 (94, 85–100) in groups A and B, respectively (p=0.18). In ROM, no significant differences were observed (p=0.43). In the radiographic assessment, one patient from each group developed a fibrous union, and one from each group had hypoplasia. There was no significant relationship between the deformity and fixation type (p=0.34, χ2 test).
CONCLUSION: Two smooth K-wires for younger children and screw fixation for children near skeletal maturity may provide favorable clinical and radiological outcomes at long-term follow-up, with low morbidity and radiographic deformity.

Pediatrik deplase mediyal epikondil kýrýklarýnýn cerrahi tedavisinde Kirschner teli veya kanüllü vida ile internal tespitin uzun dönem sonuçlarýnýn karþýlaþtýrmalý çalýþmasý: 42 olgunun 10 yýllýk takip sonuçlarý

AMAÇ: Literatürde, deplase mediyal epikondil kýrýklarýnýn cerrahi tedavisinde hangi tip tespit materyalinin kullanýlacaðýna karar vermenin ardýnda yatan gerekçe yeterince araþtýrýlmamýþtýr. Çalýþmamýzda, deplase mediyal epikondil kýrýðý olan çocuklarda Kirschner teli (K-teli) veya kanüllü vida ile internal tespitin uzun dönem klinik ve radyografik sonuçlarýný karþýlaþtýrýldý.
GEREÇ VE YÖNTEM: 5 mm’den daha fazla yer deðiþtirmiþ mediyal epikondil kýrýklarý için cerrahi tedavi uygulanmýþ toplam 42 çocuk iki gruba ayrýldý. Grup A, K-telleri ile internal tespit uygulanmýþ 22 çocuk içerirken, grup B kanüllü vida ile tespit uygulanmýþ 20 çocuktan oluþuyordu. Ortalama yaþ grup A’da 9 yýl (ortanca, 10.5; aralýk, 6–14) iken, grup B’de 15 yýldý (16, 10–17). Toplam takip süresi 10 (ortanca, 10; aralýk, 5–15) yýl olarak hesaplandý. Hastalarýn klinik sonuçlarýný deðerlendirmek için, son takipteki dirsek hareket açýklýðýna (ROM) ek olarak Mayo Dirsek Performans Skorlarý (MEPS) kullanýldý. Radyografik deðerlendirme sýrasýnda, son takip radyografileri üzerinde epikondil kýrýðýna ikincil olasý deformiteler incelendi.
BULGULAR: Ortalama MEPS, A ve B gruplarýnda sýrasýyla 95 (ortanca, 95; aralýk, 85–100) ve 93 (94, 85–100) olarak tespit edildi (p=0.18). ROM’da anlamlý bir fark gözlenmedi (p=0.43). Radyografik incelemede her gruptan birer hasta fibröz kaynama saptanýrken, her gruptan birer hastada hipoplazi mevcuttu. Deformite ve tespit tipi arasýnda anlamlý iliþki saptanmadý (p=0.34, χ2 testi).
TARTIÞMA: Deplase mediyal epikondil kýrýklarýnýn cerrahi tedavisinde, iskelet olgunluðuna yakýn çocuklar için vida ile tespit, daha küçük çocuklar için iki adet K-teli ile internal tespit düþük morbidite ve radyografik deformite oranlarý ile uzun süreli takiplerde olumlu klinik ve radyolojik sonuçlar saðlayabilir.