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Repair of supracondylar humerus fractures in children: does pin spread matter?

Chad E Aarons1, Christopher Iobst, Daniel B Chan

  • 1Tuckahoe Orthopaedic Associates, Richmond, VA, USA. caarons@msn.com

Journal of Pediatric Orthopedics. Part B
|August 28, 2012
PubMed

Insights

Pin spread ratio (PSR) in pediatric supracondylar humerus fractures appears sufficient for fixation. Studies found no association between PSR and fixation loss with lateral pinning, but noted one for type III fractures with crossed pinning.

Area of Science:

  • Pediatric Orthopedics
  • Surgical Techniques
  • Fracture Management

Background:

  • Supracondylar humerus fractures are common in children.
  • Surgical repair often involves lateral or crossed pinning.
  • The significance of pin divergence (pin-spread ratio) is not well understood.

Purpose of the Study:

  • To investigate the association between pin-spread ratio (PSR) and fixation loss in pediatric supracondylar humerus fractures.
  • To compare the outcomes of lateral versus crossed pinning techniques regarding PSR and fixation.
  • To determine if current PSRs are adequate for stable fracture repair.

Main Methods:

  • Retrospective review of surgeon's experience with crossed (N=46) and lateral (N=57) pinning techniques.
  • Calculation of pin-spread ratio (PSR) as the distance between pins divided by fracture width.
  • Assessment of fixation loss by measuring changes in Baumann's angle.

Main Results:

  • No significant association was found between PSR and change in Baumann's angle for lateral pinning.
  • An association between PSR and change in Baumann's angle was observed for type III fractures treated with crossed pinning.
  • The study suggests current PSRs are generally adequate for maintaining fixation.

Conclusions:

  • The pin-spread ratio (PSR) in pediatric supracondylar humerus fracture repair appears sufficient.
  • Lateral pinning showed no PSR-fixation loss correlation, while crossed pinning did for type III fractures.
  • Current surgical practices for pin divergence in these fractures likely ensure adequate stability.

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