{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T18:34:21Z","timestamp":1775759661849,"version":"3.50.1"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although the pathophysiology of Gartland Wilkins type 2 (GW 2) and 3 (GW 3) fractures is comparable, there are distinctive nuances regarding anatomical compromise and fracture stability. These differences may imply unique trajectories of functional rehabilitation, radiological outcomes and reduction-related complications, but consequential differences in treatment outcomes have not been studied thoroughly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Goal<\/jats:title>\n                    <jats:p>To describe complications after K-wire fixation of supracondylar humeral fractures in children, and identify differences in postoperative outcomes between GW2 and GW3 fractures following K-wire fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective single-center cohort study was conducted. Children below 16 years of age that underwent K-wire fixation of a supracondylar fracture between January 2013 and October 2023 were identified. Patient characteristics, functional and radiological outcomes and postoperative complications were collected and compared between patients with GW 2 and GW 3 fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 178 patients were included in the analyses, of which 14.0% had a postoperative complication. The GW grade 3 group had a shorter time between trauma and surgery (p\u2009&lt;\u20090.001), a longer time between surgery and K-wire removal (34.5 versus 31.7 days, p\u2009=\u20090.008) and a longer time between surgery and cast removal (34.9 versus 32.8 days, p\u2009=\u20090.017) than the GW grade 2 group. The GW-grade 3 group had a significantly lower rate of closed reduction than the GW-grade 2 group (48.4% versus 77.1%, p\u2009&lt;\u20090.001). The GW3 group had a significantly higher rate of complications than the GW2 group (21.1% versus 6.0%, p\u2009=\u20090.005). This was mainly due to a higher rate of loss of reduction (0.0% versus 9.5%, p\u2009=\u20090.004). Rates of infection, nerve damage and chronic pain were also higher in the GW3 group, although not significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this cohort, 14.0% of all patients had a postoperative complication. GW3 fractures treated with K-wires were found to have significantly more complications than GW2 fractures. Also, the rate of loss of reduction was significantly higher in the GW3 group.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0345622","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T17:38:54Z","timestamp":1775756334000},"page":"e0345622","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differences in postoperative complications and elbow function between K-wire fixation of Gartland Wilkins type 2 and 3 supracondylar humeral fractures in children"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5477-0228","authenticated-orcid":true,"given":"Stijn","family":"van Cruchten","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert F.","family":"Pull ter Gunne","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edo J.","family":"Hekma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victor A.","family":"de Ridder","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4895-9806","authenticated-orcid":true,"given":"Diederik P. J.","family":"Smeeing","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"issue":"7","key":"pone.0345622.ref001","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1097\/BPO.0000000000000154","article-title":"Potential causes of loss of reduction in supracondylar humerus fractures","volume":"34","author":"AT Pennock","year":"2014","journal-title":"J Pediatr Orthop"},{"issue":"2","key":"pone.0345622.ref002","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1007\/s11999-014-4033-8","article-title":"Classifications in brief: the Gartland classification of supracondylar humerus fractures.","volume":"473","author":"TB Alton","year":"2015","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"pone.0345622.ref003","doi-asserted-by":"crossref","first-page":"993","DOI":"10.2106\/00004623-194830040-00023","article-title":"The treatment of supracondylar fractures of the humerus by Kirschner-wire transfixion","author":"AL Swenson","year":"1948","journal-title":"J Bone Joint Surg Am"},{"key":"pone.0345622.ref004","volume-title":"Dutch Guideline Fractures in Children: Treatment of Distal Humeral Fractures in Children","author":"SM Sintenie","year":"2019"},{"key":"pone.0345622.ref005","article-title":"Supracondylar humerus fractures","author":"N Hope","year":"2023","journal-title":"Treasure Island"},{"issue":"5","key":"pone.0345622.ref006","doi-asserted-by":"crossref","first-page":"735","DOI":"10.2106\/00004623-200105000-00013","article-title":"Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement","volume":"83","author":"DL Skaggs","year":"2001","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"pone.0345622.ref007","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.ocl.2007.12.005","article-title":"Pediatric supracondylar fractures and pediatric physeal elbow fractures","volume":"39","author":"MW Shrader","year":"2008","journal-title":"Orthop Clin North Am"},{"issue":"4","key":"pone.0345622.ref008","article-title":"Factors Influencing Functional Outcomes in Supracondylar Humerus Fractures: A Retrospective Study of Paediatric Patients in a Level One Trauma Centre","volume":"15","author":"P Poulios","year":"2023","journal-title":"Cureus"},{"key":"pone.0345622.ref009","first-page":"235","article-title":"Short-Term Management Outcomes of Supracondylar Fractures of the Humerus and Their Associated Factors in Children Managed at Mulago National Referral Hospital","volume":"14","author":"AA Sheikdon","year":"2022","journal-title":"Orthop Res Rev"},{"key":"pone.0345622.ref010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","author":"E von Elm","year":"2007","journal-title":"PLoS Med"},{"issue":"2","key":"pone.0345622.ref011","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"D Dindo","year":"2004","journal-title":"Ann Surg"},{"issue":"2","key":"pone.0345622.ref012","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2106\/00004623-197456020-00004","article-title":"Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years\u2019 experience with long-term follow-up","volume":"56","author":"JC Flynn","year":"1974","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"pone.0345622.ref013","doi-asserted-by":"crossref","first-page":"7949","DOI":"10.4081\/or.2019.7949","article-title":"Factors influencing the complication rate in pediatric supracondylar humerus fractures","volume":"11","author":"D K\u00f6rner","year":"2019","journal-title":"Orthop Rev (Pavia)"},{"issue":"2","key":"pone.0345622.ref014","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s12306-018-0578-0","article-title":"Surgical treatment of pediatric supracondylar humerus fracture could be safely performed by general orthopedists","volume":"103","author":"P Osateerakun","year":"2019","journal-title":"Musculoskelet Surg"},{"issue":"4","key":"pone.0345622.ref015","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/0020-1383(91)90001-U","article-title":"Management of displaced supracondylar fractures of the humerus in children","volume":"22","author":"M Furrer","year":"1991","journal-title":"Injury"},{"issue":"6","key":"pone.0345622.ref016","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1097\/BPB.0000000000000582","article-title":"Surgical management of Gartland type III supracondylar humerus fractures in older children: a retrospective study","volume":"28","author":"M Li","year":"2019","journal-title":"J Pediatr Orthop B"},{"issue":"34","key":"pone.0345622.ref017","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000016862","article-title":"Auxiliary Kirschner wire technique in the closed reduction of children with Gartland Type III Supracondylar humerus fractures","volume":"98","author":"L Dong","year":"2019","journal-title":"Medicine (Baltimore)"},{"issue":"4","key":"pone.0345622.ref018","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1111\/os.12504","article-title":"Prognostic Factors for the Outcome of Supracondylar Humeral Fractures in Children","volume":"11","author":"DS Wendling-Keim","year":"2019","journal-title":"Orthop Surg"},{"key":"pone.0345622.ref019","article-title":"Risk factors for loss of fixation in pediatric supracondylar humeral fractures","author":"T Sangkomkamhang","year":"2014","journal-title":"J Med Assoc Thai"},{"issue":"6","key":"pone.0345622.ref020","doi-asserted-by":"crossref","first-page":"690","DOI":"10.4103\/0019-5413.104219","article-title":"A retrospective analysis of loss of reduction in operated supracondylar humerus fractures","volume":"46","author":"B Balakumar","year":"2012","journal-title":"Indian J Orthop"},{"issue":"5","key":"pone.0345622.ref021","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.cjtee.2019.06.002","article-title":"Multicentre collaborative cohort study of the use of Kirschner wires for the management of supracondylar fractures in children","volume":"22","author":"H Claireaux","year":"2019","journal-title":"Chin J Traumatol"},{"issue":"3","key":"pone.0345622.ref022","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/BPB.0000000000000417","article-title":"Risk of infection and secondary displacement in pediatric supracondylar or lateral condyle fractures treated with unburied Kirchener-wires removed before complete bone healing","volume":"26","author":"S Aubret","year":"2017","journal-title":"J Pediatr Orthop B"},{"issue":"4","key":"pone.0345622.ref023","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/S0020-1383(02)00312-1","article-title":"Neurovascular complications and functional outcome in displaced supracondylar fractures of the humerus in children","volume":"34","author":"T Gosens","year":"2003","journal-title":"Injury"},{"issue":"6","key":"pone.0345622.ref024","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.otsr.2012.03.021","article-title":"Compared outcomes after percutaneous pinning versus open reduction in paediatric supracondylar elbow fractures","volume":"98","author":"JB Yaokreh","year":"2012","journal-title":"Orthop Traumatol Surg Res"},{"issue":"4","key":"pone.0345622.ref025","doi-asserted-by":"crossref","first-page":"702","DOI":"10.2106\/00004623-200404000-00006","article-title":"Lateral-entry pin fixation in the management of supracondylar fractures in children","volume":"86","author":"DL Skaggs","year":"2004","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"pone.0345622.ref026","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/BPB.0000000000000797","article-title":"Normal values and ranges of the lateral capitello-humeral angle in healthy children","volume":"30","author":"Y Kiyota","year":"2021","journal-title":"J Pediatr Orthop B"},{"issue":"12","key":"pone.0345622.ref027","doi-asserted-by":"crossref","first-page":"2901","DOI":"10.1007\/s00264-023-05765-2","article-title":"Clinical and radiographic outcomes after paediatric supracondylar humeral fractures treated with combined intramedullary and lateral wire fixation: our experience in fifty-one cases","volume":"47","author":"A Ben Fredj","year":"2023","journal-title":"Int Orthop"},{"issue":"1","key":"pone.0345622.ref028","first-page":"15","article-title":"Comparative Study of Stabilization of Humerus Supracondylar Fracture in Children by Percutaneous Pinning From Lateral Side and Both Sides","volume":"28","author":"MK Roy","year":"2019","journal-title":"Mymensingh Med J"},{"issue":"6","key":"pone.0345622.ref029","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1097\/00005131-199509060-00009","article-title":"Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children","volume":"9","author":"JC Cheng","year":"1995","journal-title":"J Orthop Trauma"},{"issue":"3","key":"pone.0345622.ref030","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1302\/0301-620X.88B3.17181","article-title":"Early versus delayed treatment of extension type-3 supracondylar fractures of the humerus in children","volume":"88","author":"M Sibinski","year":"2006","journal-title":"J Bone Joint Surg Br"},{"key":"pone.0345622.ref031","first-page":"38","article-title":"Crossed-pin versus lateral-pin fixation in pediatric supracondylar fractures.","volume":"56","author":"SA Shamsuddin","year":"2001","journal-title":"Med J Malaysia"},{"issue":"5","key":"pone.0345622.ref032","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.cjtee.2015.08.003","article-title":"Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus: A rare injury","volume":"18","author":"K Vishal","year":"2015","journal-title":"Chin J Traumatol"},{"issue":"2","key":"pone.0345622.ref033","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/01.bpb.0000236236.49646.03","article-title":"Vascular complications of supracondylar humeral fractures in children","volume":"16","author":"S Luria","year":"2007","journal-title":"J Pediatr Orthop B"},{"issue":"4","key":"pone.0345622.ref034","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1302\/0301-620X.88B4.17491","article-title":"Delay increases the need for open reduction of type-III supracondylar fractures of the humerus","volume":"88","author":"PJ Walmsley","year":"2006","journal-title":"J Bone Joint Surg Br"},{"issue":"8","key":"pone.0345622.ref035","article-title":"Delayed Open Reduction and K-Wire Fixation of Widely Displaced Supracondylar Fractures of Humerus in Children using Medial Approach","volume":"10","author":"S Waikhom","year":"2016","journal-title":"J Clin Diagn Res"},{"issue":"7","key":"pone.0345622.ref036","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.otsr.2012.07.005","article-title":"Delayed treatment of supracondylar elbow fractures in children","volume":"98","author":"JB Yaokreh","year":"2012","journal-title":"Orthop Traumatol Surg Res"},{"issue":"11","key":"pone.0345622.ref037","doi-asserted-by":"crossref","first-page":"1871","DOI":"10.1007\/s43465-022-00734-0","article-title":"Early Versus Delayed Treatment for Gartland Type III Supracondylar Humeral Fractures in Children: A Systematic Review and Meta-analysis","volume":"56","author":"G Ismayl","year":"2022","journal-title":"Indian J Orthop"},{"issue":"1","key":"pone.0345622.ref038","first-page":"1","article-title":"Percutaneous K wire fixation in pediatric lateral condylar fractures of humerus: A prospective study","volume":"62","author":"R Lal Sahu","year":"2018","journal-title":"Rev Esp Cir Ortop Traumatol (Engl Ed)"},{"issue":"2","key":"pone.0345622.ref039","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.jcot.2019.01.013","article-title":"Comparison of clinic-radiological outcome of cross pinning versus lateral pinning for displaced supracondylar fracture of humerus in children: A randomized controlled trial","volume":"11","author":"SF Afaque","year":"2020","journal-title":"J Clin Orthop Trauma"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345622","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T17:39:01Z","timestamp":1775756341000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0345622"}},"subtitle":[],"editor":[{"given":"Xiaoen","family":"Wei","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":39,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0345622","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]}}}