Exposed versus buried K-wire fixation in paediatric lateral condyle humerus fractures: preliminary communication of a prospective comparative study

Buried Kirschner's wires (K-wires) following internal fixation of paediatric Lateral condyle fracture of humerus allow them to hold the bone until radiological consolidation but requires another surgical procedure for implant removal. Exposed wires need meticulous pin tract care, earlier implant removal and may carry a higher risk of infection. The objective of this study was to compare the outcomes of buried versus exposed K-wires for these fractures. This prospective comparative(nonrandomised) study was conducted from July 2016 to April 2020 at a tertiary care level I trauma centre on 80 children, <12 years of age, divided into group 1(n = 40), where K-wires were left exposed, and group 2 (n = 40), where K-wires were buried. Functional outcome and complications were compared between the two groups with at least 3 months follow-up. Infection rate was significantly lower in buried K-wire group with 7 patients (17.5%) compared to 15 (37.5%) in exposed group, P = 0.045. Four out of those 15 patients needed debridement suggesting that exposed K-wires carry a higher risk of bone infection and subsequent morbidities. There was no significant difference in union time, range of motion (mean flexion 135.3 degrees in exposed vs. 132.5 degrees in buried, P = 0.988), carrying angle (8.5 degrees vs. 8.6 degrees, P = 0.981), or lateral condyle hypertrophy; 12 (30%) vs. 9 (22.5%), P = 0.446. Skin pigmentation was more in the exposed group; 13 (32.5%) vs. 10 (25%), P = 0.459. We recommend that K-wires should be buried subcutaneously, particularly when meticulous pin tract care is doubtful.