Comparison of clinic-radiological outcome of cross pinning versus lateral pinning for displaced supracondylar fracture of humerus in children: A randomized controlled trial

Abstract

Introduction: Supracondylar fracture of humerus (SFH) is frequently encountered in the immature skeleton, [1] predominantly in the non-dominant extremity. Aim: This study compared the clinic-radiological outcome between cross pinning with lateral pinning for fixation of displaced supracondylar fracture of humerus in children. Materials and methods: All eligible patients were randomized into two groups, group I for lateral pinning and group II for cross pinning. Before passing medial pin in group II a stab incision was given to visualise the medial epicondyle. Patients were followed up on 3 weeks, 6 weeks and 3 months. Final outcome was measured in terms of clinic-radiological union, Baumann angle, loss of reduction, stability of fracture fixation, incidence of iatrogenic nerve injury and Flynn's score. Results: There were 37 patients in group I and 40 in group II. Both groups were comparable in terms of demographic details. At the final outcome there were no difference in between the groups in terms of all radiological and clinical outcome. Two patients of group I developed delay ulnar neuritis, which resolve completely in subsequent follow-up. Conclusion: Both techniques provide stable fixation, union and good functional outcome without iatrogenic ulnar nerve injury provided that small incision sufficient enough to identify the medial epicondyle is given with passing of medial pin.

Supracondylar Fractures of the Humerus: Association of Neurovascular Lesions with Degree of Fracture Displacement in Children—A Retrospective Study

“…Larson et al reported that crossed pinning is biomechanically more stable than lateral pin constructs but carries a higher risk of ulnar nerve injury during the insertion of the medial pin [35]. Afaque et al and Pavone et al demonstrated that there is no significant difference between lateral pinning and crossed pinning in terms of functional outcome, biomechanical stability, and incidence of complications [10,36].…”

Open Reduction of Supracondylar Humerus Fractures in Children for Failed Closed Reduction: Outcome of Delayed Treatment

“…Meanwhile, playing caused the maximum injury (45.2%) in the late group, which is consistent with other studies. [10][11][12][13] The treatment option besides closed reduction is opening reduction with pinning. Open reduction is indicated in the cases of failed closed reduction, loss of pulse or poorly perfused hand following reduction and in the case of open fracture.…”

“…However, recent literature show the use of only lateral pinning as sufficient for fixing supracondylar fracture. [11][12][13][14][15] Bayisenga J. et al evaluated the early outcome of open reduction and internal fixation of Lagrange & Rigault stage IV supracondylar humerus fractures in children in Rwanda, using K-wires pinning. The result confirmed the method's effectiveness, especially in cases of delayed treatment and in settings with no intensifier imaging.…”

Medial and Lateral Crossed-Pinning Versus Only Lateral Pinning in the Treatment of Supracondylar Fractures of Humerus a Retrospective Comparative Clinical Study

“…In addition, the complex vascular and neural structures surrounding the elbow make these structures prone to injury during trauma and surgery. Cubitus varus has been reported to be between 5 and 15% after surgical treatment (6,7), and it has been reported that ulnar nerve injury can be seen in 15% of the patients after medial pinning (8). The surgery recommended to be performed is the fixation of the fracture with the pins after an open or a closed reduction.…”