Cannulated screw versus kirschner wire fixation for pediatric medial epicondylar fractures: Focusing on pain management and complication patterns

Abstract

Objective: To evaluate and compare pain management, complication patterns, and functional outcomes between cannulated screw and Kirschner wire fixation for treating pediatric medial epicondylar fractures. Method: A retrospective cohort study was conducted at a tertiary hospital from 2013 to 2023, involving 31 pediatric patients with displaced medial epicondylar fractures (Watson-Jones Types III and IV). Patients were divided into two groups: 16 received cannulated screw fixation, while 15 underwent Kirschner wire fixation. Clinical outcomes, including operation time, fracture healing, pain levels, and complications, were assessed. Results: Both groups demonstrated similar long-term functional outcomes, with no significant difference in Mayo Elbow Performance Scores (p > 0.05). The cannulated screw group experienced significantly lower pain on the third postoperative day compared to the Kirschner wire group (p < 0.001). The Kirschner wire group had a higher rate of pin-track infections (13.3%) and delayed union (6.7%), whereas the cannulated screw group had fewer complications, with one case of superficial wound infection. Hardware removal occurred significantly earlier in the Kirschner wire group (p < 0.001). Conclusion: Both fixation methods offer effective treatment for pediatric medial epicondylar fractures, with cannulated screws providing better pain control and fewer complications but requiring longer retention. Kirschner wires allow for earlier removal but carry a higher risk of infection and delayed healing. Treatment decisions should be individualized, considering factors such as pain sensitivity, family preferences, and medical resources.