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Comparative analysis of pinning techniques for supracondylar humerus fractures in paediatrics: A systematic review
S Umar Hasan1, Alina Pervez1, Shajie Ur Rehman Usmani2
1Aga Khan University, Karachi, Pakistan.
Insights
Lateral pinning for pediatric supracondylar humeral fractures (SCHFs) is safer, significantly reducing iatrogenic ulnar nerve injury risk compared to cross pinning. Other outcomes were similar between these common pediatric fracture fixation methods.
Area of Science:
- Pediatric Orthopedics
- Surgical Techniques
- Evidence-Based Medicine
Background:
- Supracondylar humeral fractures (SCHFs) are common in children.
- Optimal surgical fixation methods for pediatric SCHFs lack consensus.
- Pinning techniques are frequently employed for SCHF treatment.
Purpose of the Study:
- To compare the safety and efficacy of cross pinning versus lateral pinning for pediatric SCHFs.
- To evaluate outcomes including iatrogenic ulnar nerve injury, functional results, and infection rates.
- To provide evidence-based recommendations for surgical technique selection in pediatric supracondylar humeral fracture management.
Main Methods:
- Systematic review and meta-analysis of 22 Randomized Controlled Trials (RCTs).
- Data extraction on Baumann's angle, carrying angle, elbow function (Flynn criteria), pin tract infection, and ulnar nerve injury.
- Random effects modeling used for statistical analysis of outcomes.
Main Results:
- A significantly higher risk of iatrogenic ulnar nerve injury was observed with cross pinning (OR 3.76).
- No significant differences were found between cross pinning and lateral pinning for other assessed outcomes.
- Data from 20 RCTs contributed to the ulnar nerve injury analysis.
Conclusions:
- Lateral pinning is recommended over cross pinning to minimize the risk of iatrogenic ulnar nerve injury in pediatric SCHFs.
- Surgeons should consider lateral pinning for enhanced patient safety.
- Both techniques demonstrate comparable results for other intraoperative and postoperative outcomes.
Purpose:
Supracondylar humeral fractures (SCHFs) rank among the frequently observed fractures in children. Nonetheless, there exists a dearth of consensus regarding the optimal surgical approach. This meta-analysis aims to thoroughly evaluate and compare two distinct pinning techniques (cross pinning versus lateral pinning) for SCHFs, using data from Randomized controlled trials (RCTs).
Methods:
Literature review was done using PubMed, CINAHL, Scopus, and The Cochrane Library for RCTs comparing the two pinning methods and providing information on at least one of the following: Loss of Baumann's angle, loss of carrying angle, elbow function assessed based on Flynn criteria, pin tract infection, and iatrogenic ulnar nerve injury. Random effect model was used to calculate standardized mean difference or Odds Ratio (OR) for the outcomes. Review Manager 5.4.1. was used to perform quality assessment and statistical analysis.
Results:
A total of 22 RCTs were included. 20 studies reported data for iatrogenic ulnar nerve injury, the OR was calculated to be 3.76 (95% CI 1.75-8.06), showing a significantly lower risk of surgical ulnar nerve injury with the lateral technique. However, no significant difference was found between the pinning techniques in regard to the other outcomes.
Conclusion:
In comparison to lateral pinning, the utilization of cross pinning technique exposes the patient to a heightened susceptibility of iatrogenic nerve injury. Therefore, it is recommended that surgeons prioritize the implementation of the lateral pinning technique whenever feasible, as it offers greater protection against iatrogenic ulnar nerve injury. For the other intraoperative and postoperative outcomes, both surgical techniques yield comparable results.
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