Differences in postoperative complications and elbow function between K-wire fixation of Gartland Wilkins type 2 and 3 supracondylar humeral fractures in children

Abstract

Background Although the pathophysiology of Gartland Wilkins type 2 (GW 2) and 3 (GW 3) fractures is comparable, there are distinctive nuances regarding anatomical compromise and fracture stability. These differences may imply unique trajectories of functional rehabilitation, radiological outcomes and reduction-related complications, but consequential differences in treatment outcomes have not been studied thoroughly. Goal To describe complications after K-wire fixation of supracondylar humeral fractures in children, and identify differences in postoperative outcomes between GW2 and GW3 fractures following K-wire fixation. Methods A retrospective single-center cohort study was conducted. Children below 16 years of age that underwent K-wire fixation of a supracondylar fracture between January 2013 and October 2023 were identified. Patient characteristics, functional and radiological outcomes and postoperative complications were collected and compared between patients with GW 2 and GW 3 fractures. Results A total of 178 patients were included in the analyses, of which 14.0% had a postoperative complication. The GW grade 3 group had a shorter time between trauma and surgery (p < 0.001), a longer time between surgery and K-wire removal (34.5 versus 31.7 days, p = 0.008) and a longer time between surgery and cast removal (34.9 versus 32.8 days, p = 0.017) than the GW grade 2 group. The GW-grade 3 group had a significantly lower rate of closed reduction than the GW-grade 2 group (48.4% versus 77.1%, p < 0.001). The GW3 group had a significantly higher rate of complications than the GW2 group (21.1% versus 6.0%, p = 0.005). This was mainly due to a higher rate of loss of reduction (0.0% versus 9.5%, p = 0.004). Rates of infection, nerve damage and chronic pain were also higher in the GW3 group, although not significant. Conclusion In this cohort, 14.0% of all patients had a postoperative complication. GW3 fractures treated with K-wires were found to have significantly more complications than GW2 fractures. Also, the rate of loss of reduction was significantly higher in the GW3 group.