Does the Direction of Kirschner Wire Fixation in Pediatric Supracondylar Humerus Fractures Really Matter?

作者：Zhiyang Yin, Xiuning Chen, Qiang Li, Yulong Ben, Pengfei Zheng · 发表于：Journal of Pediatric Orthopaedics · 年份：2025 · DOI：10.1097/bpo.0000000000003134 · 研究领域：Elbow and Forearm Trauma Treatment、Shoulder Injury and Treatment、Shoulder and Clavicle Injuries

BACKGROUND: Supracondylar humerus fracture (SCHF) is the most common elbow fracture in children. For displaced fractures, percutaneous Kirschner wire (K-wire) fixation is the preferred treatment. Although standard wire placement is traditionally recommended, clinical constraints-such as soft tissue swelling, limited surgical access, and variable anatomy-may necessitate deviations from standard configurations. This study aimed to evaluate the clinical efficacy and safety of nonstandard K-wire placement in pediatric SCHF, providing evidence to support practical surgical decision-making. METHODS: A retrospective analysis was conducted on pediatric patients treated for supracondylar humerus fractures between January 2022 and December 2023. A total of 526 patients met the inclusion criteria. On the basis of the fixation method, patients were categorized into a lateral K-wire fixation group (including a standard placement subgroup with 164 cases and a nonstandard placement subgroup with 124 cases) and a crossed medial-lateral K-wire fixation group (including a standard placement subgroup with 134 cases and a nonstandard placement subgroup with 104 cases). Various clinical and radiographic parameters were compared, including baseline data, surgical time, intraoperative fluoroscopy times, pin separation ratio (PSR), pin crossing angle (PCA), radiographic alignment, and functional outcomes at follow-up. RESULTS: Baseline characteristics were comparable across all 4 groups (P>0.05). Am...