Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta‐analysis of randomized control trials

Abstract

Background Supracondylar humerus fractures are common in children. Percutaneous pinning remains the mainstay in treatment; however, there is lack of consensus on the optimal configuration: lateral‐only pinning or cross pinning. This study aims to investigate the differences in clinical and surgical outcomes between lateral‐only and cross‐pinning paediatric supracondylar humerus fractures. Methods A systematic search was performed using Medline Ovid, Embase and Cochrane databases for relevant randomized control trials comparing lateral and cross pinning of paediatric supracondylar humerus fractures, reporting at least one of the following: rate of iatrogenic ulnar nerve injury, loss of reduction, infection, loss of Baumann's angle and loss of carrying angle. Statistical analysis was performed using STATA 13.0. Results Eleven suitable randomized control trials involving 900 patients were reviewed. Loss of reduction was more common with lateral pinning (relative risk 1.44, 95% confidence interval 1.04–2.00, P = 0.027). Iatrogenic ulnar nerve injury was less common in lateral pinning with treatment‐based analysis (relative risk 0.36, 95% confidence interval 0.14–0.92, P = 0.032). There was no statistically significant difference in loss of carrying angle, loss of Baumann angle or rate of infection. Conclusion Cross pinning provides superior stability in the treatment of supracondylar humerus fractures in children; however, it carries greater risk of iatrogenic ulnar nerve injury.

Comparison of Outcome of Lateral Pinning Versus Medial and Lateral Cross Pinning in Childhood Supracondylar Fractures of Humerus

“…17 Another recent meta-analysis by Kwok et al including 11 studies reported that lateral pinning is associated with higher loss of reduction and had lower risk of iatrogenic ulnar nerve injury. 18 In our study, the radiologic and functional outcomes were almost similar between the groups. But there was difference between two techniques in safety of ulnar nerve as there were four injuries to ulnar nerve in cross pin group (4.2%) and none in lateral pin technique which were neuropraxia type and recovered fully in 3 months.…”

Lateral entry pins and Slongo’s external fixation: which method is more ideal for older children with supracondylar humeral fractures?

“…In this study, pin tract infection occurred in one case of the external fixation group, which may be related to the local skin tension and the larger diameter of the Schanz screw. Although some studies have shown that the mechanical effect of inserting anti-rotating Kirschner wire from the inside is better [ 32 ], there is still a risk of iatrogenic ulnar nerve injury [ 33 ]. Therefore, we recommended the lateral entry anti-rotating Kirschner wire.…”

Medial–lateral versus lateral-only pinning fixation in children with displaced supracondylar humeral fractures: a meta-analysis of randomized controlled trials

“…Some meta-analyses found comparable construct stability and functional outcomes between both pinning configurations and recommended lateral pinning as a result of decreased risk ulnar nerve injury [ 9 , 14 , 15 ]. Some did not prioritize the fixation techniques because of a less fixation stability of lateral pinning but a higher risk of ulnar nerve risk of crossed pinning [ 7 , 12 , 13 ]. The inconsistency may be caused by the inclusion of non-randomized controlled trials (non-RCTs), i.e., retrospective case–control or prospective cohort studies, that have a low evidence level or a small number of eligible RCTs.…”

“…Several meta-analyses comparing the efficacy and safety of crossed pin fixation versus lateral pin fixation in children with SCHFs have been published [7,[9][10][11][12][13][14][15]. Yet, the results are mixed.…”