The aims of this study were (1) to ascertain prospectively whether rotational instability can be determined intraoperatively and (2) to quantify the incidence of rotational instability after lateral-entry wire fixation in type-3 supracondylar humeral fractures in children according to Wilkins modification of Gartland classification. (Fractures in Children. Vol 3. 4th ed. 1996:669-750). Twenty-one consecutive patients admitted with type-3 supracondylar fractures at the Children's Hospital at Westmead were surgically treated according to a predetermined protocol. After closed fracture reduction, 2 lateral-entry wires were inserted under radiographic control. Stability was then assessed by comparing lateral fluoroscopic images in internal and external rotation. If the fracture remained rotationally unstable, a third lateral-entry wire was inserted, and images were repeated. A medial wire was used only if instability was demonstrated after the insertion of 3 lateral wires. Rotational stability was achieved with 2 lateral-entry wires in 6 cases, 3 lateral-entry wires in 10 cases, and with an additional medial wire in 5 cases. Our results were compared with a control group of patients treated at our hospital before the introduction of this protocol. No patients required a reoperation after the introduction of our protocol as opposed to 6 patients in the control group. On analysis of radiographs, the protocol resulted in significantly less fracture position loss as evidenced by change in Baumann angle (P < 0.05) and lateral rotational percentage (P < 0.05). We conclude that supracondylar fractures that are rotationally stable intraoperatively after wire fixation are unlikely to displace postoperatively. Only a small proportion (26%) of these fractures were rotationally stable with 2 lateral-entry wires.
- Rotational stability
- Supracondylar humeral fracture