Roshan Raghavan1, Alistair Jones2, Amitabh J Dwyer3. 1. Orthopaedic Surgery, Borders General Hospital, Huntlyburn Melrose TD6 9BS, Scotland, UK. 2. Orthopaedic surgery, Yeovil Hospital, Higher Kingston Yeovil BA21 4AT, Somerset, UK. 3. Orthopaedic Surgery, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Hinchingbrooke Park Huntingdon PE29 6NT, Cambridgeshire, UK. Electronic address: amitabhdwyer@yahoo.com.
Abstract
BACKGROUND: Displaced lateral humeral condyle fractures in children are usually treated with open reduction and internal fixation. When treated operatively with Kirschner wires, the bent cut near side wire ends are either buried in the subcutaneous tissue or are left exposed. It is believed that burying the wires allows them to remain in longer and hence facilitate better union. Leaving them exposed seems to necessitate earlier removal, especially to reduce the risk of wire tract infection. There is not a clear consensus in published literature whether subcutaneous wire burial is better or not. PATIENTS AND METHODS: A systematic review of literature was performed using online database EMBASE, Pubmed, Medline, CINAHL and Cochrane database. The inclusion criteria comprised only those studies that compared lateral humeral condyle fracture fixation in children with wires buried subcutaneously versus those left exposed to skin. RESULTS: Of the four studies identified, three reported that it was safe to leave the wires exposed and that there was no statistically significant advantage of burying the wires with regards to risk of infection. However, our meta-analysis of the four studies demonstrated on forest plot charts that there is an increased risk of infection when the wires are left exposed (odds ratio 0.538 CI 0.437-0.639), but the overall complication rate was less in the group treated with exposed wires. Treatment with exposed wires was also cost effective when compared to treatment with buried wires. DISCUSSION: Our review concluded that despite a higher risk of superficial infections, exposed wires are safe and an economical option when fixing lateral humeral condyle fractures in children. LEVEL OF EVIDENCE: II, systematic review.
BACKGROUND: Displaced lateral humeral condyle fractures in children are usually treated with open reduction and internal fixation. When treated operatively with Kirschner wires, the bent cut near side wire ends are either buried in the subcutaneous tissue or are left exposed. It is believed that burying the wires allows them to remain in longer and hence facilitate better union. Leaving them exposed seems to necessitate earlier removal, especially to reduce the risk of wire tract infection. There is not a clear consensus in published literature whether subcutaneous wire burial is better or not. PATIENTS AND METHODS: A systematic review of literature was performed using online database EMBASE, Pubmed, Medline, CINAHL and Cochrane database. The inclusion criteria comprised only those studies that compared lateral humeral condyle fracture fixation in children with wires buried subcutaneously versus those left exposed to skin. RESULTS: Of the four studies identified, three reported that it was safe to leave the wires exposed and that there was no statistically significant advantage of burying the wires with regards to risk of infection. However, our meta-analysis of the four studies demonstrated on forest plot charts that there is an increased risk of infection when the wires are left exposed (odds ratio 0.538 CI 0.437-0.639), but the overall complication rate was less in the group treated with exposed wires. Treatment with exposed wires was also cost effective when compared to treatment with buried wires. DISCUSSION: Our review concluded that despite a higher risk of superficial infections, exposed wires are safe and an economical option when fixing lateral humeral condyle fractures in children. LEVEL OF EVIDENCE: II, systematic review.