Comparative study of crossed pinning v/s lateral pinning in paediatric supracondylar humerus fractures

Dev Krishan Sharma; Mahendra Solanki; Sunita Solanki; Akshaj E. P.

doi:10.18203/issn.2455-4510.IntJResOrthop20243889

Authors

Dev Krishan Sharma Department of Orthopaedics, MGM Medical College, Indore, Madhya Pradesh, India
Mahendra Solanki Department of Orthopaedics, MGM Medical College, Indore, Madhya Pradesh, India
Sunita Solanki Department of Physiology, MGM Medical College, Indore, Madhya Pradesh, India
Akshaj E. P. Department of Orthopaedics, MGM Medical College, Indore, Madhya Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243889

Keywords:

Supracondylar humerus fractures, Iatrogenic ulnar nerve injury, Pinning

Abstract

Background: Closed reduction and percutaneous pinning are the preferred management of supracondylar humerus fractures in children, but the preference of pinning pattern needs more research. A prospective comparative interventional study was undertaken to compare the stability of fixation, functional outcome and neurovascular complications between crossed pinning and lateral pinning in Gartland type 2 and type 3 fractures.

Methods: 60 patients of age group 2 to 12 years with Gartland’s type 2 and 3 fracture were randomized into 2 groups- lateral pinning (n=30) and crossed pin fixation (n=30). Intraoperative parameters were compared, post operative ulnar nerve palsy and serial range of motion were assessed. At 3 month follow up, outcome was assessed using Flynn criteria. The results were compared and analysed.

Results: There were 2 cases (3.3%) of iatrogenic ulnar nerve injury in crossed pinning group and none in lateral pinning group. Lateral group had more cases with excellent Flynn rating. The mean loss of range of motion and the mean loss of carrying angle was significantly lower for lateral method.

Conclusions: Lateral pinning provides, better functional outcome along with comparable stability without the risk of iatrogenic ulnar nerve injury.

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References

Naik LG, Sharma GM, Badgire KS, Qureshi F, Waghchoure C, Jain V, et al. Pinning in supracondylar fracture of humerus. J Clin Diagn Res. 2017;11(8):1-3.

Herring JA. Tachdjian’s Pediatric Orthopaedics. 3rd ed. Philadelphia: W.B. Sanders. Fracture about the elbow. 2002;3:2139-221.

Kocher MS, Kasser JR, Waters PM, Syder BD, Hresko MT, Hedequist D, et al. Lateral entry compared with medial and lateral pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. J Bone Joint Surg Am. 2007;89(4):706-12.

Ramachandran M, Skaggs DL, Crawford HA, Eastwood DM, Lanlode FD, Vitale MG, et al. Delaying treatment of supracondylar fractures in children: has the pendulum swung too far? J Bone Joint Surg Br. 2008:90(9):1228-33.

Kruschemandl I, Aldrian S, Kottstorfer J, Seis A, Thalhammer G, Egkher A. Crossed pinning in paediatric supracondylar humerus fractures: a retrospective cohort analysis. Int Orthop. 2012;36(9)1893-8.

Shamim B. Outcome of paediatric supracondylar fractures 0f humerus with closed reduction and Percutaneous Fixation with 2 Crossed K-Wires. Ind J Orthopaed Surg. 2016;2(1):42-7.

Kasser JR, Beaty JH. Supracondylar fractures of the distal humerus. In: Rockwood and Wilkins’

Gartland JJ. Management of supracondylar fracture of humorous in children. Surg: Gynecol Obstet 1959;109:145-54.

Shoaib M, Hussaian A, Kamran H, Ali J. Outcome of closed Reduction and casting in displaced Supracondylar Fraction of Humerus in children. J Ayub Med Coll Abottabad. 203;15:23-5.

Wilkins KE. The operative management of supracondylar fractures. Orthop Clin North Am. 1990;21(2):269–89.

Brauer CA, Lee BM, Bae DS, Waters PM, Kocher MS. A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop. 2007;27(2):181-6.

Larson L, Firoozbakhsh K, Passarelli R, Bosch P. Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. Journal of Pediatric Orthopaedics. 2006;26(5):573-8.

Prashant K, Lakhotia D, Bhattacharyya TD, Mahanta AK, Ravoof A. A comparative study of two percutaneous pinning techniques (lateral vs medial-lateral) for Gartland type III pediatric supracondylar fracture of the humerus. J Orthop Traumatol. 2016;17(3):223-9.

Barr LV. Paediatric supracondylar humeral fractures: epidemiology, mechanisms and incidence during school holidays. J Child Orthop. 2014;8(2):167–70.

Khwaja MK, Khan WS, Ray P, Park DH. A Retrospective Study Comparing Crossed and Lateral Wire Configurations in Paediatric Supracondylar Fractures. Open Orthop J. 2017;11:432-8.

Lyons JP, Ashley E, Hoffer MM. Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop. 1998;18(1):43–5.

Skaggs DL, Cluck MW, Mostofi A, Flynn JM, Kay RM. Lateral-entry pin fixation in the management of supracondylar fractures in children. J Bone Joint Surg Am. 2004;86(4):702-7.

Na Y, Bai R, Zhao Z, Han C, Kong L, Ren Y, Liu W. Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis. J Orthop Surg Res. 2018;13(1):68.

Zhao JG, Wang J, Zhang P. Is lateral pin fixation for displaced supracondylar fractures of the humerus better than crossed pins in children? Clin Orthop Relat Res. 2013;471(9):2942-53.

Vito P, Riccioli M, Gianluca T, Ludovico L, Cristo C, Condorelli G, et al. Surgical treatment of displaced supracondylar pediatric humerus fractures: comparison of two pinning techniques. J Funct Morphol Kinesiol. 2016;1:39-47.

Kwok SM, Clayworth C, Nara N. Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta-analysis of randomized control trials. ANZ J Surg. 2021;91:980-5.