A study comparing two different pinning techniques in supracondylar fractures of the humerus

Abstract

Various treatment options are available for treating type III supracondylar fractures of the humerus. The most common technique employed is closed manipulative reduction with K wire fixation. This study was performed to compare two different pinning techniques in type III supracondylar fractures of the humerus. This study was done in the time frame between January 2012 to December 2015. The age of the children selected for this study ranged from 3 to 12 years of age. Among 66 children, 6 were lost to follow up and the final number was 60 children. Patients with lateral pin fixation were allotted to group A(n=29), while patients with cross pin fixation technique were allotted to Group B(n=31). All patients were assessed for loss of fracture reduction and the occurrence of ulnar nerve injury. The two groups were evaluated at regular intervals from the first week to a time frame of 6 months. In both groups of patients, there was no loss of fracture reduction observed. The various parameters pertaining to the study were evaluated and there was no statistical significant difference found between the 2 groups. In group B, 3 of the children had injury to the ulnar nerve. Both groups were comparable in terms of fracture healing duration, loss in the reduction of the fracture and the stability provided by the pin constructs. In conclusion, both fixation constructs are comparable in terms of stability, but there are higher chances of iatrogenic injury to the ulnar nerve by using the crossed pinning technique. Hence, we conclude that the lateral pin construct is safer as compared to the cross pin method.

Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning? A retrospective cohort study

“…In their systematic review, Brauer et al 10 found that iatrogenic nerve injury occurred in 3.5% of patients who had cross pinning and in 1.9% of patients with lateral pinning. In spite of the higher incidence of nerve injury with cross pinning, 14 its superior biomechanical stability is well established. 10,15 Lateral pinning was suggested by the American Academy of Orthopaedic Surgeons (AAOS) to avoid ulnar nerve injury with a weak level of evidence.…”