Mostofi Zadeh Haghighi D L, Xu J, Campbell R, Moopanar T R
Sydney Medical School, The University of Sydney, Camperdown, NSW, 2050, Australia.
Department of Orthopaedic and Trauma Surgery, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
Musculoskelet Surg. 2025 Mar;109(1):9-15. doi: 10.1007/s12306-024-00859-5. Epub 2024 Aug 8.
This systematic review compares Kirschner wires versus a single cannulated screw for the treatment of lateral humeral condyle fractures in children. The purpose of this review is to review the current literature on fixation of lateral condyle fractures of the humerus, and to ascertain whether there is a difference in clinical outcomes of these fractures when fixated with K-wires vs screws. This systematic review of the literature comparing surgical management of paediatric (0-17 years of age) lateral condyle fractures with K-wire versus screw fixation was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches of three databases from inception to March 2022 yielded 17 studies which satisfied inclusion criteria, comprising 1,272 patients with a median age of 8.5 years. Eight hundred and fifty-five (67.2%) patients underwent K-wire fixation and 417 (32.8%) underwent screw fixation. Results were divided into comparative and single-arm studies. The median follow-up time was 23.3 months (range 3 months-22 years). A lateral prominence was observed in 114 (13.3%) patients with K-wires and 41 (9.8%) patients with a cannulated screw. An infection developed in 52 (6.1%) patients with K-wires, while only five (1.2%) patients with a screw developed an infection. A carrying angle deformity occurred in 61 (7.1%) patients with K-wires and seven (1.7%) patients with a screw. K-wires and cannulated screws are effective and safe methods of fixation for lateral humeral condyle fractures in children. K-wire fixation may have a greater incidence of infection but allows for safe non-operative removal and versatility with fractures of greater comminution, while screw fixation necessitates a second operation for removal following union.Level of Evidence III Systematic review.
本系统评价比较了克氏针与单根空心螺钉治疗儿童肱骨外侧髁骨折的效果。本评价的目的是回顾目前关于肱骨外侧髁骨折固定的文献，并确定使用克氏针与螺钉固定这些骨折时临床结果是否存在差异。本系统评价使用系统评价和Meta分析的首选报告项目（PRISMA）指南，对比较克氏针与螺钉固定治疗儿童（0至17岁）外侧髁骨折的手术管理的文献进行了研究。对三个数据库从建库至2022年3月进行电子检索，共获得17项符合纳入标准的研究，包括1272例患者，中位年龄为8.5岁。855例（67.2%）患者接受了克氏针固定，417例（32.8%）患者接受了螺钉固定。结果分为比较研究和单臂研究。中位随访时间为23.3个月（范围3个月至22年）。114例（13.3%）接受克氏针固定的患者和41例（9.8%）接受空心螺钉固定的患者出现了外侧突出。52例（6.1%）接受克氏针固定的患者发生了感染，而接受螺钉固定的患者中只有5例（1.2%）发生了感染。61例（7.1%）接受克氏针固定的患者和7例（1.7%）接受螺钉固定的患者出现了提携角畸形。克氏针和空心螺钉是治疗儿童肱骨外侧髁骨折的有效且安全的固定方法。克氏针固定可能感染发生率更高，但允许安全地非手术取出，并且对于粉碎性骨折具有通用性，而螺钉固定在骨折愈合后需要二次手术取出。证据等级III系统评价。
