Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis

Na, Yuyan; Bai, Rui; Zhao, Ziyan; Han, Changxu; Kong, Lingyue; Ren, Yizhong; Liu, Wanlin

doi:10.1186/s13018-018-0768-3

Cited by 29 publications

(44 citation statements)

References 33 publications

(20 reference statements)

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“…Supracondylar humerus fractures are one of the most common elbow injuries in children 1,2 . The supracondylar region is at high risk of fracture due to thin structure between coronoid and olecranon fossae and predisposition to bending forces when falling on outstretched hand 1,3 . Cubitus varus is the most common complication, resulting from poor or loss of reduction 4 .…”

Section: Introductionmentioning

confidence: 99%

Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta‐analysis of randomized control trials

Kwok

Clayworth

Nara

2021

ANZ Journal of Surgery

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Background Supracondylar humerus fractures are common in children. Percutaneous pinning remains the mainstay in treatment; however, there is lack of consensus on the optimal configuration: lateral‐only pinning or cross pinning. This study aims to investigate the differences in clinical and surgical outcomes between lateral‐only and cross‐pinning paediatric supracondylar humerus fractures. Methods A systematic search was performed using Medline Ovid, Embase and Cochrane databases for relevant randomized control trials comparing lateral and cross pinning of paediatric supracondylar humerus fractures, reporting at least one of the following: rate of iatrogenic ulnar nerve injury, loss of reduction, infection, loss of Baumann's angle and loss of carrying angle. Statistical analysis was performed using STATA 13.0. Results Eleven suitable randomized control trials involving 900 patients were reviewed. Loss of reduction was more common with lateral pinning (relative risk 1.44, 95% confidence interval 1.04–2.00, P = 0.027). Iatrogenic ulnar nerve injury was less common in lateral pinning with treatment‐based analysis (relative risk 0.36, 95% confidence interval 0.14–0.92, P = 0.032). There was no statistically significant difference in loss of carrying angle, loss of Baumann angle or rate of infection. Conclusion Cross pinning provides superior stability in the treatment of supracondylar humerus fractures in children; however, it carries greater risk of iatrogenic ulnar nerve injury.

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Section: Introductionmentioning

confidence: 99%

Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta‐analysis of randomized control trials

Kwok

Clayworth

Nara

2021

ANZ Journal of Surgery

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“…Multiple studies have shown that both crossed and lateral pinning configurations are comparable in terms of stiffness. However, because crossed pins are the most implicated in iatrogenic ulnar nerve injury, some of these studies have therefore advocated for lateral pinning alone as the preferred pinning technique for SHFs, as it offers comparable stability as crossed pins and has reduced or no risk of iatrogenic ulnar nerve injury [3, 6–9]. Loss of reduction is another theoretical complication of pinning fixation method which has been attributed to many factors [10, 11, 15–18].…”

Section: Discussionmentioning

confidence: 99%

“…Lateral entry pinning is however preferred by many surgeons because it can achieve sufficient stability while eliminating the risk of ulnar nerve injury [6–9]. The configuration of the pins should be in accordance with the fracture line to achieve the best stability.…”

Section: Introductionmentioning

confidence: 99%

A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

Kamara

Wang

et al. 2019

J Orthop Surg Res

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BackgroundKirschner wire fixation remains to be the mainstream treatment modality in unstable or displaced supracondylar humerus fracture in children, with divergent lateral pins being the most preferred due to their sufficient stability and decreased risk of ulnar nerve injury. However, the entry point at which the proximal lateral pin can be inserted to achieve a more proximal exit and maximum divergence has not been reported. This study retrospectively analyzed the characteristics and factors influencing the entry and exit points of the proximal lateral pins.MethodsThe study was divided into two stages. In stage one, the entry and exit points of the proximal pins of lateral pinning configuration were analyzed from intra-operative radiographs of children treated for extension-type supracondylar humerus fractures. The coronal and sagittal pin angles formed by the proximal pins were also measured. Using the findings of stage one, we intentionally tried to achieve a more proximal exit with the proximal pins in stage two. Comparisons between groups of patients treated by random and intentional pinnings were done statistically.ResultsIn the first stage, 47 (29.2%) of the 161 proximal pins exited above the metaphyseal-diaphyseal junction (MDJ) region. Of these, 85.1% entered from lateral and posterior to the ossific nucleus of the capitellum (ONC). The pin angles averaged 58.4° and 90.5° in the coronal and sagittal planes respectively. In the second stage, 47 (65.3%) proximal pins in the intended group exited above the MDJ region, while only 32 (36%) in the random group exited above the MDJ region.ConclusionWhile aiming at the upper border of the distal MDJ during pinning, lateral pins can easily achieve a higher, proximal exit above the MDJ if inserted from lateral and posterior to the ONC and parallel to the humeral shaft in the sagittal plane. Higher exit can also be easily achieved in younger patients and patients fixated with smaller diameter pins.

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“…The non-dominant arm of boys aged five to seven years is most frequently involved. Extension type supracondylar fractures are the most frequent (99%) fracture type [1]. The mechanism of injury is secondary to a fall onto an outstretched hand [2][3].…”

Section: Introductionmentioning

confidence: 99%

“…Provided that adequate reduction has been obtained, Gartland I and II-type fractures are usually stabilized by nonsurgical means while Gartland III fractures are almost routinely treated by closed reduction and percutaneous pinning (CRPP) [2][3][4]. In 20% of the cases, open reduction may be necessary to obtain an acceptable result [1]. However, it seems that the displaced extension type supracondylar fractures of the pediatric elbow, collectively described as Gartland III-type fractures, are not a homogenous group.…”

Section: Introductionmentioning

confidence: 99%

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method

Samelis

Papagrigorakis²,

Ellinas

2019

Cureus

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The posterior fat pad sign (PFPS) on the lateral elbow X-ray is useful in the diagnosis of a suspected nondisplaced fracture about the elbow after a subtle injury. However, the presence of a PFPS hallmarks a continuous posterior periosteum-posterior capsule of the distal humerus. This anatomic structure is crucial for the stable anatomic reduction of a displaced extension type supracondylar fracture. Subsequently, the presence of a PFPS may predict the successful nonoperative treatment of a Gartland III-type fracture by means of the Blount method, implying less implant-related morbidity and less intraoperative radiation exposure for the patient and surgeon. Furthermore, it is concluded that a PFPS-positive displaced extension type supracondylar fracture is definitively classified as a Gartland III and not a Gartland IV-type fracture. A retrospective study of 75 displaced extension type supracondylar elbow fractures was performed. All fractures had an initial attempt at a closed reduction under general anesthesia. A stable reduction in 120 degrees of elbow flexion without vascular compromise of the affected limb was achieved in 45 fractures, which were splinted in this position. In the remaining 30 cases, fracture reduction was either inadequate or was achieved with excess elbow flexion, which impaired distal blood flow. These fractures were pinned percutaneously and splinted in 90 degrees of elbow flexion. The two treatment groups were retrospectively compared for the presence of a PFPS. The displaced extension type supracondylar fractures, which were treated successfully by the Blount method, had a statistically significant higher prevalence (chi-square-Yates =4.91, p<0.05) of a positive PFPS (28/45 patients, 62.22%) compared to the fractures treated by closed reduction and percutaneous pinning (10/30, 33.33%). No vascular complications were observed. The long-term outcome did not differ between groups.

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Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis

Cited by 29 publications

References 33 publications

Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta‐analysis of randomized control trials

Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta‐analysis of randomized control trials

A two-stage retrospective analysis to determine the effect of entry point on higher exit of proximal pins in lateral pinning of supracondylar humerus fracture in children

Role of the Posterior Fat Pad Sign in Treating Displaced Extension Type Supracondylar Fractures of the Pediatric Elbow Using the Blount Method

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