Efficacy and Safety of Closed Reduction Percutaneous Pinning versus Open Reduction with Kirschner Wire Fixation for Paediatric Lateral Humeral Condyle Fractures: a Meta-analysis

Abstract

Background Traditionally, open reduction with Kirschner wire fixation (ORKF) is used to treat paediatric patients with significantly displaced lateral humeral condyle fractures. However, in recent years, the use of closed reduction percutaneous pinning (CRPP) to treat lateral humeral condyle fractures in children has been increasingly reported. However, there is some controversy as to which surgical technique is more effective and safe. Objective To evaluate the efficacy and safety of CRPP and ORKF in paediatric patients with lateral humeral condyle fractures. Methods Chinese databases including CNKI, Wanfang Data, VIP and CBM and English databases including PubMed, Embase, Cochrane Library and Web of Science were searched from inception to 2023-01-01 for the case-control studies of CRPP and ORKF to treat the lateral humeral condyle fractures, the quality of the literature was evaluated and data were extracted. RevMan 5.3 software was performed to conduct a meta-analysis comparing the relevant efficacy and safety indexes of the two surgical techniques. Results A total of 16 studies involving 1 165 cases were included for this meta-analysis. The results of meta-analysis indicated that CRPP was superior in status of surgical time (MD=-11.81, 95%CI=-15.04 to -8.58, P<0.000 01), intraoperative bleeding (MD=-3.36, 95%CI=-4.37 to -2.36, P<0.000 01), postoperative fracture healing time (MD=-3.92, 95%CI=-6.80 to -1.03, P=0.008), Kirschner wire rtention time (MD=-3.35, 95%CI=-6.33 to -0.38, P=0.03), and postoperative functional recovery of elbow joint (OR=0.44, 95%CI=0.25 to 0.76, P=0.006). The incidence of overall postoperative complications (OR=0.33, 95%CI=0.19 to 0.56, P<0.000 1) and superficial infections (OR=0.39, 95%CI=0.21 to 0.73, P=0.003) was lower than that in the ORKF group. However, there is no statistically significant difference in the deep infections, poor fracture healing, and ischemic necrosis of the lateral condyle between the two groups (P>0.05) . Conclusion CRPP was superior to ORKF in the treatment of pediatric lateral humeral condyle fractures, both in terms of efficacy and overall complications, but more high-quality studies are needed to further validate CRPP in terms of specific complications.

Keywords

• fracture fixation|humeral lateral condylar fracture|closed reduction percutaneous pinning|open reduction with kirschner wire fixation|child|meta-analysis