Comparative study between two crossing medial-lateral K-wire fixation and three lateral K-wire fixation for supracondylar fracture (Gartland III) in children

Background: Dislocated supracondylar humerus fractures are often treated with closed reduction and percutaneous pinning (CRPP). While crossed pinning offers strong fixation, it could cause damage to the ulnar nerve. Three lateral K-wires may reduce this risk while maintaining stability, but the ideal pin configuration remains controversial. This study aimed to compare the clinical and radiological outcomes of 3-lateral K-wire fixation versus two crossing wire fixation in treatment of supracondylar humerus fracture (Gartland type III) in children. Methods: 24 juvenile patients with Gartland type III supracondylar humerus fractures were included in this prospective comparative study. They were split evenly into two groups. Group 2 received three lateral K-wires, whereas Group 1 received medial-lateral crossed K-wire fixation. All surgeries were performed under general anesthesia, and Patients were monitored for a minimum of three months. Postoperative evaluation included complication rates, elbow range of motion, Flynn grading, and carrying angle measurement to assess alignment and functional outcomes. Results: Flynn’s grading demonstrated comparable functional outcomes in range of motion loss (excellent: 75% in Group 1vs. 66.7% in Group 2) and carrying angle loss (excellent:66.7% in Group 1vs. 58.3% in Group 2), with no statistically significant differences. Baumann’s angle was similar between groups (69.1°±4.86vs. 68.8°±5.11; p> 0.05). No cases of iatrogenic ulnar nerve injury or loss of reduction were reported. Pin tract infections occurred equally (one case per group) and resolved without sequelae. Conclusion: Both crossed and three-lateral K-wire fixation techniques provide comparable clinical and radiological outcomes for Gartland type III supracondylar humerus fractures in children.