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Supracondylar fractures of the humerus occur frequently in children and account for approximately 70% of all elbow fractures. The aim of this systematic review is to critically appraise randomized controlled trials in the literature comparing the outcome of surgical treatment of extension type Gartland III supracondylar fractures using either a cross pin configuration or lateral pins only for fixation in terms of the stability of fixation and the incidence of encountered complications. Only 4 randomized trials were found over the past 10 years. These were reviewed according to the CONSORT 2010 check list. No study found any significant statistical difference in terms of loss of reduction between the two groups, suggesting similar stability of both constructs. There is currently, however, no Level 1 evidence comparing the outcome of crossed pinning versus lateral entry pinning in extension type Gartland III supracondylar fracture. Additionally, the current highest level evidence discussed above has limitations ranging from small sample size to insufficient data on clinical outcome. Therefore we cannot draw any firm conclusions on the above evidence. We suggest that future RCTs take into account the recent evidence on fixation by including three lateral pins and larger diameter pins in their cohorts.

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A 2-hole locking plate (with 3.2-mm screws) provides significantly greater stability of the syndesmosis to torque when compared with 4.5-mm quadricortical fixation.