Comparative study of intramedullary K-wire vs. cross-pinning in Gartland type III supracondylar fractures: Functional results and fluoroscopy time

Background: Supracondylar humeral fractures are the most common elbow injuries in children, with Gartland type III being the most severe and requiring surgical intervention. Closed reduction with percutaneous pinning is the standard treatment, but the optimal pin configuration remains debated. Cross-pinning offers superior stability but carries a risk of ulnar nerve injury, while lateral-entry intramedullary pinning reduces nerve risk but may be biomechanically less stable. Fluoroscopy use is essential for pin placement, yet excessive exposure poses risks. Despite both techniques showing good outcomes, comparative data, especially concerning functional results and fluoroscopy time, remain limited, warranting further investigation. Aim of the study: This study compares intramedullary K-wire fixation (lateral-entry) with cross-pinning in pediatric Gartland type III supracondylar fractures, focusing on functional outcomes, fluoroscopy time, and complication rates. Methods: This prospective, comparative study was conducted over 12 months, from January to December 2024 at the Department of Orthopaedic Surgery, National Institute of Traumatology & Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh, involving 50 children (aged 4-12 years) with Gartland type III supracondylar humeral fractures. Patients were randomly assigned into two groups: Group A (n=25) underwent lateral-entry intramedullary K-wire fixation, while Group B (n=25) received cross-pinning with one medial and two lateral K-wires. Closed or mini-open reductions were performed under general anesthesia with fluoroscopic guidance. Postoperative care included splinting and physiotherapy. Outcomes were assessed using Flynn’s criteria, intraoperative parameters, and complication rates. Data were analyzed using SPSS with significance set at p0.05). Complication rates were slightly higher in Group A (12% vs. 8%), but not statistically significant. Functional and cosmetic outcomes were comparable, with Group A showing slightly higher excellent ratings, though differences were not significant (p>0.05). Conclusion: This study found that intramedullary K-wire fixation and cross-pinning effectively manage children's Gartland type III supracondylar fractures. While functional outcomes were similar, intramedullary K-wire fixation significantly reduced fluoroscopy time, suggesting better efficiency and lower radiation exposure. This technique may be preferred for minimizing complexity and radiation in pediatric settings.