Lateral Entry Compared with Medial and Lateral Entry Pin Fixation for Completely Displaced Supracondylar Humeral Fractures in Children

Kocher, Mininder S.; Kasser, James R.; Waters, Peter M.; Bae, Donald S.; Snyder, Brian D.; Hresko, M. Timothy; Hedequist, Daniel; Karlin, Lawrence I.; Kim, Young-Jo; Murray, Martha M.; Millis, Michael B.; Emans, John B.; Dichtel, Laura E.; Matheney, Travis; Lee, Ben M

doi:10.2106/jbjs.f.00379

Cited by 134 publications

(166 citation statements)

References 23 publications

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“…There were no poor results, while cases treated with lateral pinning showed 74 % excellent and 26 % good results with no poor results. Similar results were shown by Kocher et al [2], Mostafavi and Spero [22], and Aronson and Prager [23]. The difference in functional outcome between the two groups in our study was not statistically significant ( P = 0.53).…”

Section: Discussionsupporting

confidence: 91%

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

Kumar

Lakhotia

Bhattacharyya

et al. 2016

J Orthopaed Traumatol

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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.

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Section: Discussionsupporting

confidence: 91%

“…Conversely, the advantage of lateral entry pin fixation is avoidance of iatrogenic ulnar nerve injury, although the construct may be less stable biomechanically [2, 8–10]. A few studies reported that there is no significant advantage of cross pins in comparison to lateral pins [11, 12].…”

Section: Introductionmentioning

confidence: 99%

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

Kumar

Lakhotia

Bhattacharyya

et al. 2016

J Orthopaed Traumatol

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“…Two further randomised controlled trials were performed by Gaston et al [26] and Kocher et al [27] looking at 104 and 52 patients, respectively. Although both extended the elbow to over 90 degrees prior to inserting the medial K-wire to avoid injury to the ulnar nerve, only Kocher et al made an incision over the medial epicondyle.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Study Comparing Crossed and Lateral Wire Configurations in Paediatric Supracondylar Fractures

Khwaja

Khan

Ray

et al. 2017

TOORTHJ

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Background:Supracondylar fractures are common in children and are associated with significant morbidity.The purpose of our study was to assess and compare the clinical and radiological outcome of management of supracondylar fractures by both wire configurations, along with identifying factors that predispose to complications.Materials & Methods:We retrospectively reviewed all paediatric cases admitted with a supracondylar fracture over a five year period. We reviewed case notes, theatre records and radiographs to determine the age of the patient, classification of fracture, treatment method, delay to theatre, duration of surgery, wire configuration, Baumann´s angle, radiocapitellar alignment, anterior humeral alignment and complications.Results:During the five year period we admitted 132 patients and complete notes were available for 123 patients for analyses. For all the patients managed with wire stabilisation 23% developed complications, including 13% with significant complications including nerve injuries and fracture displacements. All five nerve injuries had crossed wires, whereas all for fracture displacements had lateral wires. Baumann´s angle was 76.7 degrees in the group with no complication and 72.2 degrees in the significant complication group (p=0.02). Radiocapitellar line and anterior humeral line were not satisfactory in 5% and 15% of the group with no complications, and 17% and 33% of the group with significant complications.Conclusion:We found more complications in lateral pinning configurations, although all nerve injuries were in patients with crossed wire configurations. The factors we believe are associated with a higher likelihood of complications are inadequate post-operative radiological appearance.

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“…Different techniques have been reported, but crossed pinning with postoperative immobilization is the preferred technique (Brauer et al 2007, Kocher et al 2007, Zamzam and Bakarman 2009). Iatrogenic injury to the ulnar nerve has been described in up to 20% of the cases treated with crossed pinning (Lyons et al 1998).…”

mentioning

confidence: 99%

“…Iatrogenic injury to the ulnar nerve has been described in up to 20% of the cases treated with crossed pinning (Lyons et al 1998). In addition, radial pinning may damage the radial and anterior interosseous nerve (Brauer et al 2007, Kocher et al 2007, Omid et al 2008). …”

mentioning

confidence: 99%

Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children

Eberl¹,

Eder²,

Smolle³

et al. 2011

Acta Orthopaedica

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Background and purposeUlnar nerve injury may occur after pinning of supracondylar fractures in children. We describe the outcome and compare the rates of iatrogenic injuries to the ulnar nerve in a consecutive series of displaced supracondylar humeral fractures in children treated with either crossed pinning or antegrade nailing.MethodsMedical charts of all children sustaining this fracture treated at our department between 1994 and 2009 were retrospectively reviewed regarding the mode of treatment, demographic data including age and sex, the time until implant removal, the outcome, and the rate of ulnar nerve injuries.Results503 children (55% boys) with an average age of 6.5 years sustained a type-II, type-III, or type-IV supracondylar fracture. Of those, 440 children were included in the study. Antegrade nailing was performed in 264 (60%) of the children, and the others were treated with crossed pins. Iatrogenic ulnar nerve injury occurred in 0.4% of the children treated with antegrade nailing and in 15% of the children treated with crossed pinning. After median 3 (1.6–12) years of follow-up, the clinical outcome was good and similar between the 2 groups.InterpretationIntramedullary antegrade nailing of displaced supracondylar humeral fractures can be considered an adequate and safe alternative to the widely performed crossed K-wire fixation. The risk of iatrogenic nerve injury after antegrade nailing is small compared to that after crossed pinning.

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Lateral Entry Compared with Medial and Lateral Entry Pin Fixation for Completely Displaced Supracondylar Humeral Fractures in Children

Abstract: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Cited by 134 publications

References 23 publications

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

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

A Retrospective Study Comparing Crossed and Lateral Wire Configurations in Paediatric Supracondylar Fractures

Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children

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