Crossed k-wire fixation of displaced supracondylar fractures of the humerus in children: outcomes and implications of delay in presentation

Background: Supracondylar fracture of the humerus in children is one of the most common fractures in children with peak age of occurrence from 5 to 8 years. The time of presentation and intervention of the displaced fracture greatly determine the treatment outcome. The study aims to report the outcome and implications of delayed presentation in the treatment of displaced supracondylar fractures of the Humerus in children in 63 patients. Methods: This a retrospective study of 63 paediatric patients with closed and displaced supracondylar fractures of the humeruswho presented to orthopaedic hospital Wamakko between March 2015 and January 2022. The patients’ data were obtained from the previous records and information during clinic visits while on follow-up. History and examination findings were extracted using a proformer. Radiographswere taken to determine the Gartland fracture type, Baumann’s angle, carrying angle, and reduction sufficiency. The outcomes of these measurements and assessments were determined using Flynn’s criteria. Results: The average follow-up time was 2.6 years (range 1.5 to 3.2 years). Out of the 63 cases in the study, the peak age range of presentation was 5 to 8 years with 34(54%) patients. There were 44(70%) males and 19 (30%) females with a male-to-female ratio of 2.3:1. The right sides affected were 38(60%) and left side 25(40%). The presentation time from the injury ranges from within 24 hours to 4 weeks: 16 (25%) presented within 24 hours of injury, 7(11%) between 25 and 48 hours, 11(18%) between 26 and 72 hours, 14(22%) between 4 to 7 days, 9(14%) between 1 and 2 weeks, and 6(10%) between 3 and 4 weeks. Fall on outstretched hand (FOOSH) was found in 61(97%) patients and those with elbow in flexion were found in 2(3%) patients. Twenty-seven (43%) had Gartland type 2, and 36(57%) had Gartland type 3. According to Flynn’s score 32(51%) were excellent, 21(33%) good, 7(11%) fair and 3(5%) poor. Complications at presentation were 11(17%) elbow stiffness, 3(5%) nerve palsy, and 1(2%) compartment syndrome. Fifty-one patients (81%) had percutaneous K-wire fixations, and 12(19%) patients had open reduction and K-wire fixations. The postoperative period was uneventful in 45(71%) patients while 8(13%) had Elbow stiffness, 5(8%) had wound infection, 2(3%) had nerve palsy, 2(3%) had mal-union (cubitusvarus), and 1(1%) had fracture non-union. Conclusion: Crossed K-wire fixation of displaced supracondylar fractures in children providesa stable and safe treatment method with satisfactory outcomes, especially among patients with early and timely presentations.