Children's orthopaedics

摘要

Supracondylar fractures and lateral wires X-ref Two worthwhile papers take another look at the topic of lateral wire fixation compared with the more traditional 'crossed' wire configuration in supracondylar fractures. In the first of this brace of reports, clinical results from Cairo (Egypt)1 are reported of an investigation into wire configuration and stability in supracondylar fractures. This original paper reports a randomised (allocation concealed), unblinded, controlled trial with six months' follow-up at a Level I trauma centre. It involved 60 children (mean age 5.1 years; 70% boys) and was designed to establish if there is a difference between dual lateral and crossed wires. Patients were assessed six months after closed reduction and K-wiring, and the main outcome measures were radiological evidence of fracture stability, range of motion, ulnar nerve injury, and pin-track infection. Undisplaced Gartland type I fractures, open fractures and fractures associated with vascular injury, compartment syndrome, or pre-operative ulnar nerve injury were excluded from this study. The initial findings of this paper suggest that a medial and lateral pin configuration improved stability of supracondylar humeral fractures when compared with two lateral-entry pins in children managed with closed reduction and percutaneous pinning by junior trainees. The commentary suggests that things aren't always as they seem. To the casual reader, the original paper legitimises the use of medial wires, and superficial analysis of the data tends to support this prejudice. However, there are some significant methodological deficiencies which are ably discussed in the commentary.2 There is a particular criticism about the role of junior trainees assisting junior trainees, and important confounding factors including time to procedure, swelling, and time of procedure were not mentioned in the initial paper.