Operative Treatment of Supracondylar Fractures of the Humerus in Children

Skaggs, David L.; Hale, Julia M.; Bassett, John Spencer; Kaminsky, Cornelia K.; Kay, Robert M.; Tolo, Vernon T.

doi:10.2106/00004623-200105000-00013

Cited by 329 publications

(273 citation statements)

References 16 publications

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“…For loss of reduction and deformity, inconsistent results were reported in previous studies [5,9,37,39,48,50,59]. Skaggs et al [50] retrospectively reviewed the results of reduction and pin fixation of 345 extension-type supracondylar fractures in children and found there was no difference regarding maintenance of fracture reduction between the crossed pins and the lateral pins. Omid et al [40] considered that lateral entry pins could be as stable as crossed pinning in biomechanical and clinical studies if they are well spaced at the fracture line.…”

Section: Discussionmentioning

confidence: 97%

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other surgical complications caused by pin fixation.Methods We searched PubMed, Embase, the Cochrane Library, and other unpublished studies without language restriction.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: Discussionmentioning

confidence: 97%

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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“…Most authors claim that two lateral pins alone provide adequate fixation for unstable supracondylar fractures of the humerus and avoid injury to the ulnar nerve [18,19]. Larson et al stated in their biomechanical study that medial comminution decreases fracture stability significantly and the most stable pin configuration is two lateral and one medial pin configuration against the torsional forces.…”

Section: Discussionmentioning

confidence: 99%

Operative management of type III extension supracondylar fractures in children

Kazımoğlu

Çetin

Şener

et al. 2008

International Orthopaedics (SICOT)

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The purpose of this study was to compare primarily open versus primarily closed surgical treatment of Gartland type III extension supracondylar fractures in children. Also the outcomes of different pinning techniques in open surgery were evaluated retrospectively. Eighty displaced type III extension supracondylar fractures treated consecutively at two different centres were included. The treatment protocol of one institute was primarily closed reduction and percutaneous cross-pinning (n=43). The treatment protocol of the other institute was primarily open reduction and internal fixation (n=37) with two lateral parallel pins (n=11), cross pins (n=11) and two lateral and one medial pin (n=15) according to the stability and configuration of the fracture. According to Flynn's criteria the outcomes of the open and closed reduction groups were not statistically significant (P>0.05). Although the outcomes of closed reduction showed no superiority over open reduction, it should be the first choice of treatment due to its low morbidity and short hospital stay.

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“…Biomechanical studies have shown that crossed pinning (medial and lateral) provide a more stable configuration especially against torsional loading [8,9,10] , but use of a medial pin is associated with a higher incidence of iatrogenic ulnar nerve injury (6%-12%) [6,7,9,11,12] . Several studies have tried to address the issue of lateral pin placement in the treatment of supracondylar fractures in children [4,6,7,8,[13][14][15][16][17][18] .…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have tried to address the issue of lateral pin placement in the treatment of supracondylar fractures in children [4,6,7,8,[13][14][15][16][17][18] . Clinical studies have shown that double lateral pinning alone is of equal stability when compared with crossed pins for the majority of clinical fracture scenarios [6,12] . Although some clinical studies have recommended maximum spread between divergent pins at the fracture to optimize stability [9,14,19] , but the literature is scant regarding the optimum entry point for the lateral pinning for the supracondylar humerus fracture to obtain maximum stability.…”

Section: Introductionmentioning

confidence: 99%

Lateral Pinning for Supracondylar Humerus Fracture in Children: Does The Entry Point of the Pins have an Influence on the Outcome of the Fracture Fixation?

Badami¹

2017

jmscr

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Operative Treatment of Supracondylar Fractures of the Humerus in Children

Cited by 329 publications

References 16 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?

Operative management of type III extension supracondylar fractures in children

Lateral Pinning for Supracondylar Humerus Fracture in Children: Does The Entry Point of the Pins have an Influence on the Outcome of the Fracture Fixation?

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