Crossed versus lateral K-wire fixation of supracondylar fractures of the humerus in children: a meta-analysis of randomized controlled trials

Carrazzone, Oreste Lemos; Mansur, Nacime Salomão Barbachan; Matsunaga, Fábio Teruo; Matsumoto, Marcelo Hide; Faloppa, Flávio; Belloti, João Carlos; Tamaoki, Marcel Jun Sugawara

doi:10.1016/j.jse.2020.09.021

Cited by 14 publications

(12 citation statements)

References 34 publications

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“…The disadvantage of lateral entry pinning is the increased risk of loss of reduction, which may result in cubitus varus and additional surgery, due to less biomechanical stability than medial-lateral entry pinning. Several meta-analyses incorporating only high level-of-evidence RCTs, as well as the present one, have found higher chances of loss of reduction in lateral entry pinning group [7,12,13]. The lateral pins are usually inserted in a divergent or parallel manner.…”

Section: Discussionmentioning

confidence: 67%

“…Some meta-analyses found comparable construct stability and functional outcomes between both pinning configurations and recommended lateral pinning as a result of decreased risk ulnar nerve injury [ 9 , 14 , 15 ]. Some did not prioritize the fixation techniques because of a less fixation stability of lateral pinning but a higher risk of ulnar nerve risk of crossed pinning [ 7 , 12 , 13 ]. The inconsistency may be caused by the inclusion of non-randomized controlled trials (non-RCTs), i.e., retrospective case–control or prospective cohort studies, that have a low evidence level or a small number of eligible RCTs.…”

Section: Introductionmentioning

confidence: 99%

“…Several meta-analyses comparing the efficacy and safety of crossed pin fixation versus lateral pin fixation in children with SCHFs have been published [7,[9][10][11][12][13][14][15]. Yet, the results are mixed.…”

Section: Introductionmentioning

confidence: 99%

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

2023

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Background Supracondylar humeral fractures (SCHFs) are frequent in children, and closed reduction with percutaneous pin fixation remains the standard surgical treatment for displaced SCHFs. Two pinning configurations, medial–lateral crossed entry pinning (MLP) and lateral-only entry pinning (LP), are widely used, but which one is superior to another one is still debatable. This meta-analysis aimed to compare the efficacy and safety of both pinning fixation methods. Methods Randomized controlled trials (RCTs) were searched on PubMed, EMBASE, Web of Science, Cochrane library and Google Scholar. Relative risk (RR) and mean difference (MD) with corresponding 95% confidence interval (CI) were calculated for radiographical outcomes, functional outcomes and complications. Results A total of 19 RCTs comprising 1297 Gartland type II and type III fractures were included. MLP had a decreased risk of loss of reduction (RR = 0.70, 95%CI 0.52–0.94, P = 0.018) but a higher risk of iatrogenic ulnar nerve injury (RR = 2.21, 95%CI 1.11–4.41, P = 0.024) than LP. However, no significant difference was observed for incidence of ulnar nerve injury if applying a mini-open technique in MLP group (RR = 1.73, 0.47–6.31, P = 0.407). There were no differences between both groups in loss of carrying angle (MD = − 0.12, 95%CI − 0.39 to 0.16), loss of Baumann angle (MD = 0.08, 95%CI − 0.15 to 0.30), excellent grading of Flynn criteria (RR = 1.06, 95%CI 0.99–1.14, P = 0.102) and pin tract infection (RR = 0.92, 95%CI 0.50–1.70). Conclusions MLP is more effective in maintaining fixation, while LP is safer with respect to ulnar nerve injury. MLP with a mini-open technique reduces the risk of ulnar nerve lesion and is an effective and safe choice.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

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

2023

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“…Stability Iatrogenic ulnar nerve injury O L Carrazone (22) 2020 12 ( 930 patient) Crossed pinning more stable higher risk in Crossed Y Na (23) 2018 24 (2222 patient ) Crossed pinning more stable higher risk in Crossed A E Dekker (24) 2016 13 (1158 patient) No difference higher risk in Crossed P Woratanart (25) 2012 18 (1615 patient) No difference higher risk in Crossed T Yousri (26) 2012 2 No difference higher risk in Crossed C A Brauer (27) 2007 35(2054 patient) Crossed pinning more stable higher risk in Crossed DISCUSSION:…”

Section: Authors Date No Of Studies Includedmentioning

confidence: 99%

“…Other systematic reviews were conducted comparing both techniques of fixation have reported similar results. (24)(25) (26) However, Carrazone et al (22) ,Y Na et al (23) and Brauer et al (27) reported that crossed pinning as more stable with less post-operative displacement, but with a higher risk of ulnar nerve injury compared to lateral group.…”

Section: Authors Date No Of Studies Includedmentioning

confidence: 99%

Lateral Entry Pinning and Crossed Entry Pinning in Pediatric Supracondylar Humeral Fractures Gartland Type Iii

Fahmy

Baraka

Metwally³

2021

Ain Shams Medical Journal

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Background: Supracondylar humeral fracture is a very common pediatric trauma disorder. It is very common between four and eleven years, more in boys than girls and left side affected more than right one. Major cases are extension type, which is sub classified according to Garteland classification by severity diagnosed radiologically through plain x-rays. Displaced fractures usually need fixation to avoid functional and cosmetic complications. Aim of the Work:This systematic review of literature and metaanalysis is conducted to compare between two methods of closed pinning of Gartland's III supra-condylar humeral fractures comparing lateral entry wires and crossed wires according to ulnar nerve injury and postoperative clinical and radiological outcomes. Patient and Method:Recent after 2000 clinical trials or cluster trials, prospective and retrospective comparative cohort studies. Search results will be uploaded to systematic review management software and manually screened for eligibility to be included. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart will be introduced on the search results.Data Sources: Medline databases (PubMed, Medscape, Science Direct. EMF-Portal) and all materials available in the Internet till 2020.Results: Closed reduction and per-cutaneous pinning, of supracondylar humeral fractures in children by lateral only and crossed medial and lateral wires result in similar construct stability and functional outcome, and there was significant difference between the two managements as for the complications of ulnar nerve injury which is higher in crossed pinning. Conclusion:Lateral pinning with proper technique for sake of safety and to minimize risk of ulnar nerve injury in addition to adequate stability if proper pin fixation principles are used.

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Interventions for treating supracondylar elbow fractures in children

Marson

Ikram

Craxford

et al. 2022

Cochrane Database of Systematic Reviews

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Crossed versus lateral K-wire fixation of supracondylar fractures of the humerus in children: a meta-analysis of randomized controlled trials

Cited by 14 publications

References 34 publications

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

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

Lateral Entry Pinning and Crossed Entry Pinning in Pediatric Supracondylar Humeral Fractures Gartland Type Iii

Interventions for treating supracondylar elbow fractures in children

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