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Medial and lateral pin versus lateral-entry pin fixation for Type 3 supracondylar fractures in children: a
R Glenn Gaston1, Taylor B Cates, Dennis Devito
1OrthoCarolina, Charlotte, NC 28207, USA. glenngaston@hotmail.com
Insights
This study found no significant difference in radiographic outcomes between lateral-entry and crossed pin techniques for pediatric supracondylar humerus fractures. However, medial pins were associated with ulnar nerve injuries.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Surgical techniques
Background:
- Gartland Type 3 supracondylar humerus fractures are common in children.
- Current management involves various pinning techniques.
- Comparing the efficacy of different pinning methods is crucial for optimal patient outcomes.
Purpose of the Study:
- To compare the efficacy of medial and lateral (crossed pin) versus lateral-entry pin techniques for Gartland Type 3 supracondylar humerus fractures in children.
- To evaluate radiographic maintenance of reduction, iatrogenic neurovascular complications, and infection rates.
- To provide evidence-based guidance for surgical management.
Main Methods:
- A prospective, surgeon-randomized trial involving 104 pediatric patients.
- Patients were randomized into lateral-entry pinning (47 patients) or crossed pinning (57 patients) groups.
- Radiographic outcomes and complications were assessed by a physician panel.
Main Results:
- No statistically significant difference in radiographic outcomes (Baumann's angle, humerocapitellar angle) between the two groups.
- Lateral-entry pinning showed a median change of 3.7 degrees in Baumann's angle; crossed pinning showed 2.9 degrees.
- Two cases of iatrogenic ulnar nerve injury occurred in the medial and lateral-pin group; no such injuries in the lateral-entry group.
Conclusions:
- Both lateral-entry and crossed pin techniques are effective for managing Gartland Type 3 supracondylar humerus fractures in children.
- Lateral-entry pinning may be associated with a lower risk of iatrogenic ulnar nerve injury.
- Further research may explore long-term functional outcomes and refine surgical techniques.
Background:
The purpose of this study is to compare the efficacy of medial and lateral (crossed pin) and lateral-entry pin techniques for Gartland Type 3 supracondylar humerus fractures in children.
Methods:
Six pediatric orthopaedists were divided into the 2 treatment groups (medial and lateral pins or lateral only pins) based on pre-study pinning technique preferences. Patients were randomized into 1 of the 2 pinning technique treatment groups based on which attending was on call at the time of patient presentation. One hundred and four patients met inclusion criteria. Forty-seven patients underwent lateral-entry pinning and 57 underwent crossed pinning. The 2 groups were similar with respect to age, sex, preoperative neurovascular injury, direction of fracture displacement, and timing of surgery. Outcome parameters measured included radiographic maintenance of reduction, iatrogenic neurovascular complications, and rate of infection. All radiographic measurements, and interobserver reliability, were determined by a 3 physician panel.
Results:
The results of the interobserver reliability data showed a strong correlation and this data allowed 95% confidence that a change in Baumann's angle of more than 6 degrees and humerocapitellar angle of more than 10 degrees was significant. The lateral-entry patients experienced a median absolute change of Baumann's angle of 3.7 degrees with 12 patients having greater than 6 degrees loss of reduction; whereas those in the medial and lateral-pin group saw a median change of 2.9 degrees with 10 patients having greater than 6 degrees loss of reduction. In terms of the humerocapitellar angle, the lateral-entry patients experienced a median absolute change of 4.8 degrees with 11 patients having greater than 10 degrees loss of reduction; whereas those in the medial and lateral-pin groups saw a median change of 5.1 degrees with 17 patients having greater than 10 degrees loss of reduction. There was no significant difference in infection rate between the 2 groups but 2 cases of iatrogenic neurovascular injury occurred in patients who had a medial pin placed.
Conclusions:
We found no statistical difference in the radiographic outcomes between lateral-entry and medial and lateral-pin techniques for the management of Type 3 supracondylar fractures in children when evaluated in this prospective and surgeon-randomized trial, but 2 cases of iatrogenic injury to the ulnar nerve occurred with medially placed pins.
Level Of Evidence:
Level 2.
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