K-wire versus screws in the fixation of lateral condyle fracture of humerus in pediatrics: a systematic review and meta-analysis

(2023) 24:649 Cho et al. BMC Musculoskeletal Disorders https://doi.org/10.1186/s12891-023-06780-5 BMC Musculoskeletal Disorders Open Access RESEARCH K‑wire versus screws in the fixation of lateral condyle fracture of humerus in pediatrics: a systematic review and meta‑analysis Yoon Joo Cho1*, Se Hyun Kang1 and Mu Hyun Kang1 Abstract Background Lateral condyle fracture of the humerus is the second most common elbow fracture in children. Nondisplaced lateral condyle fractures can often be managed with cast and conservative care, while reduction and fixation are often used to treat displaced lateral condyle fractures. Traditionally, K-wire fixation has been used for displaced lateral condyle fractures, but recently fixation using screws has been advocated in some studies. Therefore, we performed a meta-analysis to determine the difference in outcomes and complications between the two different fixation methods for the treatment of displaced lateral condyle fractures of the humerus in pediatric patients. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for this review. PubMed, Embase, and Cochrane Library were used for study selection. Studies comparing K-wires and screw fixation in displaced lateral condyle fractures in pediatric patients were included. Clinical outcomes using the Hardacre criteria, infection, limitation of range of motion of the elbow, lateral condyle overgrowth, delayed union, nonunion, and avascular necrosis were compared. Data were analyzed using the meta package in R version 4.2.2, and random-effects or fixed-effects models were used according to heterogeneity. Results One randomized controlled study and three retrospective cohort studies were included, with a total of 240 patients (K-wire:118, screw:122). The clinical outcome using the Hardacre criteria was not different between the groups (P = 0.54), but the risk of infection (risk ratio [RR] = 5.52, 95% CI: 1.42–21.48, P = 0.01) and limitation of range of motion (RR = 3.75, 95% CI: 1.54–9.18, P < 0.01) were significantly higher in the K-wire fixation group than in screw fixation group. Conclusions The use of screws for fixation after reduction in the treatment of lateral condyle fracture of the humerus in children decreases the risk of superficial infection and elbow stiffness compared with the use of K-wire. Although removal of the implant under general anesthesia is necessary, screw fixation can be considered in displaced lateral condyle fractures of the humerus in children. Trial registration PROSPERO (CRD42023415643). Keywords Lateral condyle fracture of the humerus, K-wire fixation, Screw fixation, Meta-analysis *Correspondence: Yoon Joo Cho 1 Department of Orthopaedic Surgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo‑Daero, Seocho‑Gu, 06591 Seoul, Korea Background In pediatrics, lateral condyle fracture is the second most common fracture of the elbow, and encompasses approximately 12% to 20% of all distal humerus fractures in children [1]. Nondisplaced fractures are usually treated with a long arm cast [2–7], but fractures with initial © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Cho et al. BMC Musculoskeletal Disorders (2023) 24:649 displacement tend to displace further and have a high incidence of nonunion, necessitating reduction and fixation [8]. Traditionally, in these fractures, open reduction and internal fixation were preferred; however, in recent studies, closed reduction and percutaneous pinning has been reported to produce similar outcomes to open reduction and fixation [9–13]. However, studies showed different methods of fixation: K-wires were traditionally used, but fixation using screws also showed tolerable results [14–16]. There is a systematic review concluding that there is no difference between the outcomes between the K-wire fixation and screw fixation [17]. However, it was only qualitatively compared, and currently, there is no meta-analysis which synthesizing the results with quantitative analysis comparing K-wire fixation with screw fixation for displaced lateral condyle fractures of the humerus in pediatrics. Therefore, we designed a meta-analysis to determine the outcome of two different fixation methods for the treatment of displaced lateral condyle fractures of the humerus in pediatric patients to provide evidence for deciding the fixation method. Methods The protocol of this study was registered in PROSPERO (ID: CRD42023415643). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting this systematic review and meta-analysis. Search Strategy The PubMed, Embase, and Cochrane Library databases were searched for articles published before April 10, 2023, that combined the terms “lateral condyle fracture of humerus” or “lateral condylar fractures of humerus” or “lateral condyle fracture of humerus” or “lateral condyle fractures of humerus” and “pediatric” or “children.” PICO (Population, intervention, comparison, and outcome) PICO was defined as following; P: Displaced lateral condyle fracture in children under the age of 16, I: Screw fixation, C: K-wire fixation, O: Postoperative clinical outcome and complications including infection, delayed union, nonunion, lateral overgrowth, limitation of range of motion, and avascular necrosis. Page 2 of 8 The inclusion criteria were articles with the preoperative diagnosis of displaced lateral condyle fracture in children under the age of 16 and including clinical outcomes of the K-wire and screw fixation groups. Studies that included combined screw and pin fixation were excluded. Only English language articles were included. Case reports, case series, reviews, systematic reviews, editorial letters, and articles without full text were excluded. This study aimed to assess the primary clinical outcome with Hardacre criteria [18] a (...truncated)