A CLOSED LOOP AUIDT OF K-WIRE POSITION AND FIXATION FAILURE RATE IN PAEDIATRIC SUPRACONDYLAR FRACTURES OVER AN 8-YEAR PERIOD IN A DGH SETTING

Erin Jones & Nicole Corin, Royal United Hospital Bath

Introduction And Aims

Supracondylar fractures are common paediatric elbow fractures. There may be associated neurovascular injury and most require surgical fixation. A 2014 audit demonstrated most fixations were with lateral wires but loss of fracture reduction was common Following a change in departmental consensus we hoped that all paediatric supracondylar fractures would be managed with at least two crossed K-wires and with no loss of reduction post operatively

Standards

BOAST supracondylar guideline: surgical stabilisation should be with at least two K-wires

Crossed wires are associated with a lower risk of loss of fracture reduction, whereas divergent lateral wires reduce the risk of injury to the ulnar nerve

Departmental consensus: supracondylar fracture should be fixed with at least 2 crossed wires

Methods

All paediatric supracondylar fractures from May 2021 to May 2022 were identified from daily trauma sheets and theatre lists There were 20 supracondylar fractures within this audit period. Operation notes, intra-operative imaging were used to determine number, size and positioning of K wires Post operative imaging and clinic letters were used to ensure satisfactory reduction was maintained. The 2021-2022 data was compared to similar data collected in 2014, 2016 and 2019 to assess practise over time

RESULTS & DISCUSSION

In our audit period 18/20 supracondylar fractures were managed with crossed K-wires and 2/20 managed with lateral K-wires All used at least 2 wires Fracture reduction was lost in 1 patient with lateral wires There were no iatrogenic ulnar nerve injuries.

This demonstrates a significant change since 2014 when 6/16 patients had crossed wires, 10/16 had lateral wires and 8/10 had loss of reduction. Sequential audit cycles have demonstrated a sustained change in practise from lateral only wires to crossed wires for supracondylar fractures

Lessons

A change in surgical practise has led to fewer patients experiencing loss of fracture reduction avoiding future morbidity and need for reintervention This has been achieved without any increase in iatrogenic ulnar nerve injuries.

Future Work

Ongoing audit of surgical practise for supracondylar fractures within our department to ensure practise maintained, including presentation at local audit meetings and to new members of department, Audit of departmental practise against remaining BOAST supracondylar standards underway