Comparative Analysis of Safety and Efficacy: Conventional Mediolateral Pinning vs. Dorgan's Lateral Cross-Pinning in...

Supracondylar fracture of the humerus (SFH) is a common occurrence in the developing skeleton, comprising a majority of all elbow injuries. Various pinning techniques have been proposed for displaced pediatric SFH, balancing the superior stability of cross pinning against its risk of ulnar nerve injury. The lateral and modified lateral cross-pinning approaches emerge as safer alternatives to prevent ulnar nerve injury. This study aims to compare the safety and efficacy of two pinning techniques, conventional mediolateral pinning and Dorgan's lateral cross-pinning, for treating Gartland type II, III, and IV supracondylar fractures in children. A systematic review and meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/Medline, Cochrane Trial Register, and Google Scholar were searched for studies comparing the two pinning techniques. The inclusion criteria involved Gartland type II, III, and IV fractures in children, including randomized controlled or observational studies, with outcomes related to functional results and ulnar nerve impingement. Quality assessment was performed using the Newcastle-Ottawa Scale. Four studies with a total of 282 participants were included. The Dorgan technique demonstrated comparable outcomes to mediolateral pinning in terms of carrying angle and range of motion. However, Dorgan's technique significantly reduced the risk of ulnar nerve impingement compared to conventional pinning (risk difference = -0.09, 95% CI = -0.13, -0.04, p = 0.0002). In the management of Gartland type II, III, and IV supracondylar fractures in children, Dorgan's lateral cross-pinning technique presents a safer alternative to conventional mediolateral pinning by significantly decreasing the risk of ulnar nerve injury. While both techniques offer comparable functional outcomes, clinicians should weigh the benefits of reduced nerve complications against potential radial nerve risks and longer treatment times associated with Dorgan's technique. Individualized decision-making considering patient factors is crucial in selecting the appropriate pinning method for optimal fracture management.