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Comparative Analysis of Postoperative Rotational Malalignment in Pediatric Supracondylar Humerus Fractures: Cross
Satoshi Muto1, Satoshi Niwa, Yuki Fujihara
1Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan.
Insights
Lateral para-olecranon pinning (LPOP) is a safe and effective alternative to cross pinning (CP) for pediatric supracondylar humeral fractures, offering shorter surgery times without compromising rotational alignment or increasing complications.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Surgical techniques
Background:
- Supracondylar humeral fractures are common pediatric injuries.
- Percutaneous pinning, including cross pinning (CP) and lateral entry pinning (LP), is a standard treatment.
- Limited research exists on rotational malalignment and comparative studies of alternative techniques.
Purpose of the Study:
- To compare rotational malalignment and clinical outcomes between CP and lateral para-olecranon pinning (LPOP).
Main Methods:
- Retrospective study of 180 pediatric patients with supracondylar humeral fractures.
- Two cohorts: LPOP (n=146) and CP (n=34).
- Primary outcome: corrective loss of rotation; Secondary outcomes: Baumann angle, carrying angle, range of motion, operative times, and complications.
Main Results:
- No significant difference in corrective loss of rotation between LPOP and CP.
- Similar outcomes for Baumann angle, carrying angle, tilting angle, and range of motion.
- Significantly shorter anesthesia and operation times in the LPOP cohort (P<0.01).
- Comparable complication rates, including reoperations and nerve injuries.
Conclusions:
- LPOP and CP yield similar rotational outcomes.
- LPOP is a safe and potentially more effective alternative due to shorter operative times.
- LPOP may lower the incidence of iatrogenic nerve injuries.
Background:
Supracondylar humeral fractures are common in children, and are typically treated with percutaneous pinning. Cross pinning (CP) and lateral entry pinning (LP) are widely used methods. Although previous studies have focused on outcomes such as Baumann and carrying angles, research on rotational malalignment is limited. Furthermore, there have been few comparative studies on alternative surgical techniques. This study aimed to compare rotational malalignment and clinical outcomes between CP and the lateral para-olecranon pinning (LPOP) technique.
Methods:
This retrospective study initially identified 208 pediatric patients who underwent percutaneous pinning for supracondylar humeral fractures between 2005 and 2023. After applying the inclusion and exclusion criteria, 180 patients were included in the study and divided into 2 cohorts: LPOP (n=146) and CP (n=34). The primary outcome was corrective loss of rotation, measured radiographically at surgery and at 4 weeks postoperatively. Rotational malalignment was assessed using the formula described by Henderson and colleagues. Secondary outcomes included Baumann angle, carrying angle, tilting angle, range of motion, anesthesia, and operation times.
Results:
No significant difference was found in corrective loss of rotation between LPOP and CP (θ=0.079±0.24 for LPOP vs. 0.10±0.20 for CP, P =0.57). Secondary outcomes, including the Baumann angle, carrying angle, tilting angle, and range of motion, were similar in both groups. However, the anesthesia and operation times were significantly shorter in the LPOP cohort ( P <0.01): the LPOP cohort had a shorter duration of anesthesia (124.95±32.22 min) than the CP cohort (148.21±65.72 min) ( P =0.009) and had a shorter operation time (52.02±31.56 min) than the CP cohort (71.82±43.69 min) ( P =0.006). Complication rates, including reoperations and nerve injuries, were comparable between the cohorts.
Conclusions:
Both LPOP and CP resulted in similar rotational outcomes; however, LPOP offered shorter anesthesia and surgery times without increasing the risk of complications. LPOP might be a safe and more effective alternative technique, showing equivalent clinical results and lowering the incidence of iatrogenic nerve injuries.
Level Of Evidence:
Level III-retrospective comparative study.
