Comparison of Two Methods of Percutaneous Pin Fixation in Displaced Supracondylar Fractures of the Humerus in Children

Foead, AI; Penafort, R; Saw, Aik; Sengupta, S

doi:10.1177/230949900401200114

Cited by 82 publications

(84 citation statements)

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“…1). According to the inclusion and exclusion criteria, seven RCTs involving 521 patients were included in this meta-analysis with individual sample sizes ranging from 40 to 160 patients (Appendix 1) [2,14,16,28,35,54,55]. Of these 521 patients, 256 were randomly assigned to the lateral entry group and 265 were assigned to the medial and lateral entry group.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Of these 521 patients, 256 were randomly assigned to the lateral entry group and 265 were assigned to the medial and lateral entry group. Three trials [16,28,55] included patients with Gartland Type III fractures and four [2,14,35,54] included patients with Gartland Types II and III fractures. Two-pin (two lateral pins or crossed pins) fixation was used initially in all trials.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…A miniopen technique of medial pinning was used in three studies [28,35,55]. Six of the trials described the time of injury [2,14,16,28,35,55] and one trial [54] was unclear (Table 1).…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…We found no studies to be of low quality. Five trials [2,14,28,35,55] reported adequate RCTs for Meta-analysis (n=7) Fig. 1 This flow chart summarizes our study selection process, the exclusion steps, and the resulting studies that were left for analysis.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…There were no major differences in five trials [16,28,35,54,55] regarding baseline characteristics, and one [14] only described the similar interval from injury to admission and surgery. It was not clear whether outcome assessors were blinded to the procedure in all trials [2,14,16,28,35,54,55]. Loss to followup rate was considered to be acceptable in all trials (within 20%).…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

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Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

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Background Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to compare (1) the risk of iatrogenic ulnar nerve injury caused by pin fixation, (2) the quality of fracture reduction in terms of the radiographic outcomes, and (3) function in terms of criteria of Flynn et al. and elbow ROM, and other surgical complications caused by pin fixation.Methods We searched PubMed, Embase, the Cochrane Library, and other unpublished studies without language restriction. Seven RCTs involving 521 patients were included. Two authors independently assessed the methodologic quality of the included studies with use of the Detsky score. The median Detsky quality score of the included trials was 15.7 points. Dichotomous variables were presented as risk ratios (RRs) or risk difference with 95% confidence intervals (CIs) and continuous data were measured as mean differences with 95% CI. Statistical heterogeneity between studies was formally tested with standard chi-square test and I 2 statistic. For the primary objective, a funnel plot of the primary end point and Egger's test were performed to detect publication bias. Results The pooled RR suggested that iatrogenic ulnar nerve injury was higher with the crossed pinning technique than with the lateral entry technique (RR, 0.30; 95% CI,. No publication bias was further detected. There were no statistical differences in radiographic outcomes, function, and other surgical complications. No significant heterogeneity was found in these pooled results. Conclusions We conclude that the crossed pinning fixation is more at risk for iatrogenic ulnar nerve injury than the lateral pinning technique. Therefore, we recommend the lateral pinning technique for supracondylar fractures of the humerus in children.

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Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…A miniopen technique of medial pinning was used in three studies [28,35,55]. Six of the trials described the time of injury [2,14,16,28,35,55] and one trial [54] was unclear (Table 1).…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

See 3 more Smart Citations

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

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Interventions for treating supracondylar elbow fractures in children

Marson

Ikram

Craxford

et al. 2022

Cochrane Database of Systematic Reviews

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The most commonly injured nerves at surgery: A comprehensive review

et al. 2020

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Iatrogenic nerve injury during surgery is a major source of concern for both patients and surgeons. This study aimed to identify the nerves most commonly injured during surgery, along with the commonly associated operative procedures. A literature search was conducted using the PubMed database to identify nerves commonly injured during surgery, along with the surgical procedure associated with the injury. The following 11 nerves, ranked in order with their associated surgical procedures, were found to be the most commonly injured: (a) intercostobrachial nerve in axillary lymph node dissections and transaxillary breast augmentations, (b) vestibulocochlear nerve in cerebellopontine tumor resections and vestibular schwannoma removals, c) facial nerve in surgeries of the inner ear and cheek region, (d) long thoracic nerve in axillary lymph node dissections, (e) spinal accessory nerve in surgeries of the posterior triangle of the neck and cervical lymph node biopsies, (f) recurrent laryngeal nerve in thyroid surgeries, (g) genitofemoral nerve in inguinal hernia and varicocele surgeries, (h) sciatic nerve in acetabular fracture repairs and osteotomies, (i) median nerve in carpal tunnel release surgeries, (j) common fibular nerve in varicose vein and short saphenous vein surgeries, and (k) ulnar nerve in supracondylar fracture surgeries. Although the root cause of iatrogenic nerve injury differs for each nerve, there are four unifying factors that could potentially decrease this risk for all peripheral nerves. These four influencing factors include knowledge of potential anatomical variations, visual identification of at‐risk nerves during the procedure, intraoperative nerve monitoring, and expertise of the surgeon.

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Comparison of Two Methods of Percutaneous Pin Fixation in Displaced Supracondylar Fractures of the Humerus in Children

Abstract: Both methods of fixation were comparable in terms of stability, duration of bone healing, and risks of injury to the nerve.

Cited by 82 publications

References 10 publications

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Interventions for treating supracondylar elbow fractures in children

The most commonly injured nerves at surgery: A comprehensive review

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