The safety and efficacy of lateral entry fixation using two K wires in a divergent configuration for Type III supracondylar fractures in children

Background: This research assessed the safety and efficacy of the divergent lateral pinning technique using two pins for the management of completely displaced extension-type supracondylar pediatric humeral fractures. Patients and methods: Thirty children (19 boys, 11 girls; mean age 7 years) with Gartland type-III fractures underwent closed reduction and percutaneous lateral divergent K-wire fixation between May 2020 and December 2022. The primary objectives included assessing the range of motion; and the carrying angle in relation to the contralateral uninjured elbow (utilizing Flynn's grading system), and determining the presence of any iatrogenic nerve or vascular injuries. Results: The right elbow was involved in 21 fractures and the left elbow was involved in 9 fractures. The mean age of the children at the time of the operation was 7 years (range, four to eleven years). The final radiographs confirmed that there was no loss of reduction in any of the fractures. Twenty six (86.7%) patients had excellent outcomes, 3 (10%) patients had good results, one patient (3.3%) had a fair result; with 13° carrying angle loss, and the appearance of the elbow was not cosmetically noticed. Two patients (6.7%) had pin track infections; and were successfully treated with oral antibiotics. There were no cases of iatrogenic ulnar nerve injury, and no reoperations were needed. Conclusion: For unstable pediatric supracondylar humeral fractures, two divergent lateral-entry pins offer secure, efficient treatment that produces good functional results with few side effects.