Operative management of supracondylar humeral fractures in children: Comparison of five fixation methods
Insights
Adding a medial pin for pediatric supracondylar humeral fractures (SHFs) improves stability and reduces displacement risk. This method, though increasing operative time, is a valuable consideration for treating SHFs in children.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Traumatology
Background:
- Supracondylar humeral fractures (SHFs) are common in children.
- Optimal fixation methods for pediatric SHFs remain debated.
Purpose of the Study:
- To compare outcomes of five distinct fixation techniques for pediatric SHFs.
- Evaluate intra-operative and short-term post-operative parameters.
Main Methods:
- Retrospective cohort study of 251 pediatric patients with displaced SHFs (2006-2016).
- Analysis of five fixation methods: ESIN, two pins (X, lateral, lateral+medial, three lateral).
- Assessment of clinical and radiological parameters, including operative time and instability.
Main Results:
- No significant difference in immediate instability across groups.
- Two lateral pins group had shorter operative time (33 min).
- Medial pin use reduced secondary displacement risk (2.0% vs. 8.6%) without increasing nerve injury risk.
Conclusions:
- Minimally invasive medial pin addition improves fracture stability and reduces displacement.
- Medial pin use is associated with longer operative time but is a viable option for pediatric SHFs.
- This study provides valuable data for optimizing pediatric SHF management.
Background:
The best method for stabilising supracondylar humeral fractures (SHFs) in children remains unclear. The objective of this study was to compare the outcomes of five different fixation methods for SHFs in children.
Hypothesis:
Differences in intra-operative and short-term post-operative parameters can be demonstrated across different fixation methods for SHFs in children.
Patients And Methods:
We reviewed the medical files of paediatric patients managed at our centre between 2006 and 2016 for SHF with major displacement (type 3 or 4 in the Lagrange-Rigault classification). Clinical and radiological parameters collected post-operatively and at last follow-up included Baumann's angle, anteversion of the distal humeral epiphysis, and operative time. Over the 11-year study period, 251 patients were included; mean age was 6.4 years and mean follow-up 4.7 months. The five fixation methods used were elastic stable intra-medullary nailing (ESIN, n=16), two pins in an X configuration (n=33), two lateral pins and one medial pin (n=144), two lateral pins (n=33), and three lateral pins (n=25). A minimally invasive 2-cm approach was used to insert the medial pins. Immediate instability of the fixation was considered in patients with an at least 15° deficit in Baumann's angle or anteversion, or with rotational malalignment, on the radiographs taken on day 1. Outcomes were analysed in each of the five internal fixation groups.
Results:
Immediate instability showed no significant differences across the five groups. Operative time was significantly shorter with two lateral pins (33min, P=0.046). Time to hardware removal was longer in the ESIN group (54 days, P=0.03). Use of a medial pin was associated with a lower risk of secondary displacement (2.0% vs. 8.6%, P=0.04) but did not affect the risk of nerve injury (4% vs. 3%, P=0.86).
Discussion:
This is one of the largest retrospective cohort studies of outcomes according to the fixation technique used to treat SHFs in children. Adding a medial pin through a minimally invasive approach is associated with a longer operative time but limits the risk of secondary displacement without increasing the frequency of iatrogenic nerve injury and improves fracture site stability. Use of a medial pin therefore deserves to be considered in paediatric SHFs.
Level Of Evidence:
IV, retrospective cohort study.
