A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus

Abstract

BackgroundThe management of displaced supracondylar fracture of the humerus with closed reduction and percutaneous pin fixation is the most widely accepted method of treatment, but controversy continues regarding the pin fixation techniques. A prospective randomized controlled study was undertaken to compare the stability, functional outcome and iatrogenic ulnar nerve injury between lateral pin fixation and medial–lateral pin fixation.Material and methodSixty-two patients with Gartland type III supracondylar fracture of the humerus were randomized into two groups—lateral pin fixation (n = 31) and medial–lateral pin fixation (n = 31). Primary assessment was performed for major loss of reduction and iatrogenic ulnar nerve injury. Secondary assessment included clinical outcome, elbow range of motion, radiographic measurements, Flynn grade, and complications.ResultsThere were two (6.5 %) iatrogenic ulnar nerve injury cases in the medial–lateral entry group and two (6.5 %) cases with mild loss of reduction in the lateral entry group. No major loss of reduction was observed in either of the groups. There was no statistically significant difference in change of Baumann angle, metaphyseal–diaphyseal angle, Flynn grade, carrying angle, and the total elbow range of motion (P < 0.05) between the two groups.ConclusionsLateral pin fixation offers similar functional and radiological outcome and almost equal mechanical stability compared with medial–lateral pinning without the risk of iatrogenic ulnar nerve injury.Level of evidence [OCEBM 2011]Level 2.

Assessment of elbow functional outcome after closed reduction and percutaneous pinning of displaced supracondylar humerus fractures in children

“…Pre-operative nerve injuries occur most commonly in older children. 3,4,14 We observed an overall incidence of 18.4% (seven children) of nerve injuries and the mean age for these children was 10 years, which confirmed the findings in the literature. Other studies in the literature have reported results within the same range.…”

“…In terms of nerve injuries associated with extension-type supracondylar fractures, the most commonly injured nerve is the radial nerve followed by the median nerve and ulnar nerve. 3,4,14 In the current study the most commonly injured nerve was the ulnar nerve (excluding iatrogenic injuries) and then the radial nerve. The ulnar nerve injury is one of the most common iatrogenic complications recorded when using the crossed-pinning technique.…”

“…Other studies in the literature have reported results within the same range. 3,4,11,14 The children with associated nerve injuries all had reduced ROM (especially extension) at final follow-up (p=0.009). In our study, there were six ulnar (16%) and one radial nerve injuries.…”

“…Closed reduction and percutaneous pinning (CRPP) of Gartland grade III supracondylar fractures in children has become the gold standard of care in the last 50 years in the global orthopaedic literature. [1][2][3][4] This is known as the modern concept of skeletal stabilisation and soft tissue management in paediatric orthopaedic surgery. Authors have cautioned against the open operative management of these fractures, and this has resulted in improved functional outcomes.…”

The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model

“…Cross pins and divergent lateral pins are said to have comparable stiffness in numerous clinical and biomechanical studies [8,9]. Many authors have however advocated for the lateral-only pins due to the risk of ulnar nerve injury with medially placed pins [10,11]. However, the use of cross pins may be inevitable in some cases, such as in medially oblique fractures, high fractures or fractures with medial comminution, which may have a higher incidence of loss of reduction in clinical practice [5].…”