ORIF with percutaneous cross pinning via the posterior approach for paediatric widely displaced supracondylar femoral fractures

Abstract

Background: Supracondylar femoral fractures are considered uncommon in children; however, they are frequently associated with complications. To date, the optimal surgical approach for these fractures remains unclear.

Objective: The aim of the present study was to determine the outcomes of open reduction with percutaneous cross pinning via the posterior approach for paediatric widely displaced, pulseless supracondylar femoral fractures refractory to closed reduction.

Methods: Between March 2007 and March 2014, 18 patients (11 boys and seven girls; average age, 6.6 years; range, 3.5-8.5 years) with widely displaced, pulseless supracondylar femoral fractures underwent ORIF with crossed percutaneous Kirschner wires via the posterior approach. The K-wires and plaster or brace were removed and knee rehabilitation exercises initiated at 4-6 weeks after surgery, and the children resumed walking at 8-10 weeks. We evaluated surgical outcomes and post-operative knee function using the Knee Society Score (KSS) scale at 6 and 12 months after surgery.

Results: Anatomical reduction was achieved in all patients. The average follow-up duration was 37 months (range, 11-60 months). The average fracture healing duration was 4.6 weeks (range, was 4-5 weeks). No patient exhibited a valgus deformity of more than 5°, nonunion, neurovascular injury and knee infection. On comparison with the contralateral limb, eight patients exhibited a ipsilateral limb length discrepancy of 1.0-2.0cm after a year. At 2 years, however, none of the patients (n=15) exhibited a discrepancy of more than 1cm. All patients showed normal function and imaging findings during the follow-up. The peak mean KSS was 95.11 at 6 months after surgery, which remained more or less constant at 12 months (95.23; n=17).

Conclusions: Our results suggest that ORIF with percutaneous cross pinning via the posterior approach ensures anatomical reduction and excellent function and is a safe, straightforward and effective procedure for paediatric widely displaced, pulseless supracondylar femoral fractures.

Level of evidence: Level III.

Keywords: Internal fixation; Open reduction; Paediatric; Posterior approach; Supracondylar femoral fractures.