Medial and Lateral Pin Versus Lateral-Entry Pin Fixation for Type 3 Supracondylar Fractures in Children

Gaston, R. Glenn; Cates, Taylor; Devito, Dennis P.; Schmitz, Michael L.; Schrader, Tim; Busch, Michael T.; Fabregas, Jorge; Rosenberg, Eli S.; Blanco, John S.

doi:10.1097/bpo.0b013e3181f73d59

Cited by 82 publications

(75 citation statements)

References 28 publications

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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%

“…Two-pin (two lateral pins or crossed pins) fixation was used initially in all trials. Of the seven studies, three justified unstable reduction using a third pin [16,54,55]. A miniopen technique of medial pinning was used in three studies [28,35,55].…”

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%

“…Randomized controlled trials (RCTs) are considered to be the most reliable form of scientific evidence in the hierarchy of evidence because they reduce spurious inferences of causality and bias. Numerous RCTs have been published on this topic [2,16,35,54,55], which provides the opportunity for us to perform a meta-analysis of RCTs comparing lateral entry pin fixation with crossed medial and lateral entry pin fixation of displaced supracondylar fractures of the humerus in children.…”

Section: Introductionmentioning

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%

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: Introductionmentioning

confidence: 99%

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