Comparison of antegrade and retrograde cross pin fixation in the surgical treatment of pediatric supracondylar femur fractures: A biomechanical study

• Published in: Injury 2024-02, Vol.55 (2), p.111284-111284, Article 111284
• Main Authors: Bulut, Tugrul, Eroglu, Osman Nuri, Husemoglu, Bugra, Onder, Yilmaz, Turgut, Ali
• Format: Article
• Language: English
• Subjects: Antegrade; Fixation; Fracture; K-wire; Pediatric; Retrograde; Supracondylar femur
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2023.111284

•Displaced pediatric supracondylar femur fractures are unstable and difficult to treat.•Antegrade or retrograde cross Kirschner wire fixation, which is especially preferred in young children, is an easier and less invasive method than other methods.•The success of this method depends on its ability to resist deforming forces. Otherwise, malalignment will be an inevitable end.•Considering that varus malalignment in lower extremity is a clinically poorly tolerated, it is clear that the resistance of this fixation method to varus loads is critical.•We found retrograde fixation to be significantly stronger/stable compared to antegrade fixation against varus loads. This data may be effective in the fixation preference of the surgeon. The aim of this study is to compare biomechanical stability of Kirschner wires (K-wires) sent with antegrade and retrograde technique in the fixation of pediatric supracondylar femur fractures. A transverse fracture model was created two centimeters above the physis in 24 synthetic bone models suitable for the pediatric femur bone structure. The models were randomly divided into two groups as 12 bones each. In the first group (Group 1), 12 bone fracture models were retrogradely fixed with two cross K-wires. In the second group (Group 2), the fracture was fixed antegradely. In Group 2, both wire ends were allowed to protrude three millimeters from the femoral condyles. The stability of the groups was tested biomechanically by exposing them to varus and extension forces. The forces corresponding to 1 mm, 2 mm, 3 mm and 4 mm displacement and failure loads were calculated in two groups. According to the test results regarding displacements and failure loads, the retrograde group was found to be significantly stronger than the antegrade group against varus loads (p  0.05). Retrograde cross K-wires fixation provides a more stable fixation against varus forces. This is important to prevent varus deformity, which is a clinically less tolerable deformity. However, considering that full-weight mobilization of patients is not allowed after surgery in pediatric supracondylar femur fractures, the surgeon should consider that K-wires can also be sent antegrade to decrease the risk of septic arthritis.