Dorgan's lateral cross-wiring of supracondylar fractures of the humerus in children: A retrospective review

Abstract 

Introduction

The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The purpose of this study was to retrospectively review a novel cross-wiring technique where the cross-wire configuration is achieved solely from the lateral side, thereby reducing the risk of ulnar nerve injury.

Methods

We retrospectively reviewed all children who had undergone this procedure at our centre over a 10-year period. The primary end points were a major loss of reduction as determined by radiological alignment and iatrogenic ulnar nerve injury. Secondary end points included clinical alignment, elbow range of motion and complications.

Results

A total of 43 patients, who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type II and type III) of the humerus were reviewed with a mean follow-up time of 36 months. No major loss of reduction occurred. The mean change in Baumann's angle (4.2±1.6°) between intra-operative and follow-up radiographs was not significant (p>0.05). No iatrogenic case of ulnar nerve injury occurred. The ‘carrying angle’ and ‘return to function’ in all children had returned to normal relative to the other side. Postoperative complications consisted of three patients developing pin-site infections, which were successfully treated.

Conclusion

Dorgan's lateral cross-wiring technique is an effective option in treating displaced supracondylar fractures of the humerus in children. It is as effective as the traditional cross-wire technique in terms of fracture healing with a reduced risk of ulnar nerve injury.

Keywords: Supracondylar fractures, Lateral cross-wiring