Comparison of Two Methods of Fixation of Supracondylar Fractures of the Humerus in Children

Abstract

Objective: To compare the outcomes of the fixation of complete and displaced supracondylar humeral fractures in children with two different Kirschner wire configurations. Methods: The type of fixation was randomized to either crossed (19 cases), or two divergent lateral Kirschner wires (24 cases). The comparison was made six months later between the two treated groups and each group with the non-fractured elbow (clinical alignment, range of motion, Baumann angle, and lateral humeral capitellar angle). Results: 43 children were evaluated (65% boys) with a mean age of six years and five months. The carrying angle (p = 0.94), extension (p = 0.89), and the Flynn´s criteria (p = 0.56) were similar between the groups. The flexion was slightly smaller for the crossed wire group (p = 0.04), but similar to the uninjured side. The Baumann angle was not different between the two fixations (p = 0.79) and the contralateral side (p = 0.1). The lateral humeral capitellar angle was slightly greater for the lateral pinning (p = 0.08), but with no difference with the uninjured elbow (p = 0.62). No iatrogenic injuries were observed. Conclusion: Both fixations presented similar outcomes that did not significantly affect the carrying angle in relation to the non-fractured side. Level of evidence II, Therapeutic study - Investigating the results of treatment.

Medial–lateral versus lateral-only pinning fixation in children with displaced supracondylar humeral fractures: a meta-analysis of randomized controlled trials

“…S6). Among seven studies using the mini-open technique [ 22 , 24 , 26 , 27 , 30 , 37 , 38 ], only 2.2% (5/230) of patients in MLP group suffered ulnar nerve injury, which did not differ from that in LP group (RR = 1.73, 95%CI 0.47–6.31, P = 0.407). However, in patients treated with crossed pin fixation but without using the mini-open technique, the incidence of ulnar nerve injury was 5.4% (17/312), which was significantly higher than 1.3% (4/305) in LP group (RR = 2.44, 95%CI 1.08–5.51, P = 0.032).…”

“…Ten studies recruited only Gartland type III fractures, eight enrolled both Gartland type II and III fractures, and one included Gartland type II, III and IV fractures [ 23 ]. Six RCTs allowed the use of a third pin if required [ 23 , 25 , 28 , 29 , 34 , 36 ], while seven trials used a medial mini-open technique [ 22 , 24 , 25 , 27 , 30 , 37 , 38 ]. The follow-up widely ranged from 1.8 to 11.43 months.…”

“…Five studies reported proper allocation concealment [ 26 , 27 , 30 , 37 , 38 ]. Patients in three trials [ 26 , 27 , 30 ] and researchers assessing outcomes in six trials [ 22 , 26 , 27 , 30 , 34 , 40 ] were not blinded to interventions. Thus, they had a high risk of performance or detection bias.…”

“…The incidence of iatrogenic ulnar nerve injury was compared in 18 RCTs (Table 2 ). Six studies observed no injury in all patients [ 22 , 27 , 30 , 35 – 37 ]. Among 542 fractures with crossed medial–lateral pinning, there were 22 cases suffering injury of iatrogenic ulnar nerve.…”

“…The literature search identified a total of 327 unique articles after removing duplicates. Finally, 19 RCTs comprising 1297 children with SCHF were included in current meta-analysis [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (Fig. 1).…”