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Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta-analysis of randomized control
Samuel M Kwok1, Catriona Clayworth2, Naveen Nara3,4,5
1Department of Orthopaedics, The Alfred, Melbourne, Victoria, Australia.
Insights
Cross pinning offers better stability for pediatric supracondylar humerus fractures but increases the risk of ulnar nerve injury. Lateral pinning is associated with a higher rate of reduction loss but fewer nerve injuries.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Supracondylar humerus fractures are prevalent in pediatric populations.
- Percutaneous pinning is the standard treatment, yet optimal pin configuration remains debated.
- Lateral-only versus cross-pinning techniques lack consensus regarding outcomes.
Purpose of the Study:
- To compare clinical and surgical outcomes of lateral-only versus cross-pinning for pediatric supracondylar humerus fractures.
- To evaluate the incidence of iatrogenic ulnar nerve injury, loss of reduction, infection, and changes in elbow angles.
Main Methods:
- Systematic review of randomized control trials (RCTs) from Medline Ovid, Embase, and Cochrane databases.
- Included studies compared lateral and cross-pinning techniques in pediatric supracondylar humerus fractures.
- Analyzed outcomes including ulnar nerve injury, loss of reduction, infection, Baumann's angle, and carrying angle.
Main Results:
- Eleven RCTs involving 900 patients were analyzed.
- Loss of reduction was significantly more frequent with lateral pinning (RR 1.44, P=0.027).
- Iatrogenic ulnar nerve injury was less common with lateral pinning (RR 0.36, P=0.032). No significant differences in infection or angular loss were found.
Conclusions:
- Cross-pinning provides superior stability for pediatric supracondylar humerus fractures.
- Lateral pinning is associated with a lower risk of iatrogenic ulnar nerve injury.
- The choice of technique involves balancing stability against potential nerve complications.
Background:
Supracondylar humerus fractures are common in children. Percutaneous pinning remains the mainstay in treatment; however, there is lack of consensus on the optimal configuration: lateral-only pinning or cross pinning. This study aims to investigate the differences in clinical and surgical outcomes between lateral-only and cross-pinning paediatric supracondylar humerus fractures.
Methods:
A systematic search was performed using Medline Ovid, Embase and Cochrane databases for relevant randomized control trials comparing lateral and cross pinning of paediatric supracondylar humerus fractures, reporting at least one of the following: rate of iatrogenic ulnar nerve injury, loss of reduction, infection, loss of Baumann's angle and loss of carrying angle. Statistical analysis was performed using STATA 13.0.
Results:
Eleven suitable randomized control trials involving 900 patients were reviewed. Loss of reduction was more common with lateral pinning (relative risk 1.44, 95% confidence interval 1.04-2.00, P = 0.027). Iatrogenic ulnar nerve injury was less common in lateral pinning with treatment-based analysis (relative risk 0.36, 95% confidence interval 0.14-0.92, P = 0.032). There was no statistically significant difference in loss of carrying angle, loss of Baumann angle or rate of infection.
Conclusion:
Cross pinning provides superior stability in the treatment of supracondylar humerus fractures in children; however, it carries greater risk of iatrogenic ulnar nerve injury.
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