Results of closed reduction and intramedullary K-wires fixation of long bones in children

ABSTRACT

To evaluate the use of long intra-medullary K-wires as a tool of fixation of long bone fresh fractures in children and to assess the rate of union and return to usual daily activity. Fifty six cases with different fractures including fracture humerus, forearm, tibia and femoral fractures were studied in the period between March 2004 and May 2008 at Saudi German Hospitals. The ages ranged from 4-13 years, male female 41 15. The ratio of humerus forearm tibia femur fractures were 17 28 7 4. Closed reduction under image was obtained in all cases and percutaneous fixation with K-wires was undertaken the diameter of K-wire differ according to the site, diameter of bone at its narrowest part and age of patient. The K-wires were embedded under the skin in femoral and tibial fractures and left protruding outside skin in forearm and most humeral fractures. Posterior slab applied for all patients in humeral and forearm fractures in the first 2 weeks then started active exercises in femoral and tibial fractures either cast or fracture braces were applied and partial weight bearing until early appearance of callus. The cases were evaluated according to union rate and return to pre-fracture activity which showed excellent results in humeral and forearm fractures with union of fracture within 4-7 weeks and return to pre-fracture activity on the 5-9 weeks. In femoral and tibial fractures the results were good for femoral fractures with union of all cases between 6-12 weeks and return to functional activity within 8-15 weeks but for tibial fractures the results were satisfactory with 2 cases of delayed union which ranged between 12-16 weeks and the rest of cases acheived full union within 8-12 weeks. But for all cases the alignment of the bone was restored and maintained. The method of percutaneous fixation of long bones fracture in children with the use of K-wires showed excellent results with rapid return to functional activity and union rate specially in humeral and forearm fractures, whereas in femoral and tibial fractures it has not show any difference in comparison to other methods of conservative treatment, the only advantage was ensuring good alignment of the bone and early rehabilitation with shorter hospital stay