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Comparison of Crossed Versus Lateral Pinning in Fixation of Extension Type of Supracondylar Humerus Fracture in
Eswaran Mythilisri1, K Rajavel1, N Gowthaman1
1Department of Orthopedics, SRM Medical College Hospital and Research Centre, Kattankulathur, Chennai, Tamil Nadu 603203 India.
Insights
Comparing pediatric supracondylar humerus fracture fixation, this study found both cross-pinning and lateral pinning offer comparable radiological outcomes. Lateral pinning demonstrated better functional results with less stiffness at four weeks.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Pediatric supracondylar humerus fractures are common injuries.
- Various fixation techniques exist, but optimal methods remain debated.
- Percutaneous pinning is a widely used fixation method.
Purpose of the Study:
- To compare functional and radiological outcomes of pediatric supracondylar humerus fracture fixation using percutaneous cross-pinning versus lateral pinning.
- To evaluate the efficacy and safety of two common pinning techniques in pediatric elbow fractures.
Main Methods:
- A prospective, single-blinded, randomized controlled trial involving 60 pediatric patients (ages <1 to 13 years) with Gartland type 2 or 3 fractures.
- Patients were randomized into two groups: 30 treated with cross-pinning and 30 with lateral pinning.
- Outcomes assessed at six months included pre- and post-operative Baumann angle, post-operative carrying angle, and Flynn criteria.
Main Results:
- No significant difference in radiological outcomes between cross-pinning and lateral pinning groups.
- All 60 patients achieved excellent functional outcomes based on Flynn criteria at six months.
- Lateral pinning showed a trend towards better functional outcomes with less stiffness at four weeks.
Conclusions:
- Both percutaneous cross-pinning and lateral pinning provide comparable bony union for pediatric supracondylar humerus fractures.
- Lateral pinning may offer superior functional outcomes, characterized by reduced stiffness and improved range of motion.
- Techniques to mitigate iatrogenic ulnar nerve injury, particularly with cross-pinning, are recommended.
Background:
Various techniques for fixation of pediatric supracondylar humerus fracture have been in practice, but which is a better option is still controversial.
Purpose Of Study:
There is a varied consensus on the outcome of fracture fixation based on different pinning methods. Hence, this study aims to compare the functional and radiological outcomes of pediatric supracondylar humerus fracture fixed by percutaneous cross-pinning or lateral pinning.
Methodology:
We conducted a prospective, single-blinded, randomized control trial with 60 patients divided into two groups of 30 each, ages ranging from less than one year to 13 years, with Gartland type 2 or 3 supracondylar humerus fractures. The outcome of fracture fixation treated with either crossed or lateral pinning was assessed with a six-month follow-up by comparing the pre-operative and post-operative Baumann angle, post-operative carrying angle and the Flynn criteria.
Result:
There was no significant difference in the radiological outcome of the supracondylar humerus fracture fixed with percutaneous cross-pinning or lateral pinning. No patient had any iatrogenic ulnar nerve injury. All 60 patients had excellent Flynn criteria at the end of the six-month follow-up.
Conclusion:
Both the techniques of percutaneous pinning showed comparable bony union. However, lateral pinning had better functional outcomes due to minimal stiffness and a good range of movements at four weeks. The iatrogenic ulnar nerve injury seen commonly in cross-pinning could be avoided with a 1 cm skin incision over the medial condyle to visualize the ulnar nerve and the medial kirschner wire entry made anteriorly.
Clinical Trial Registry-India Registration Number:
CTRI202404066233.
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