Crossed pinning in paediatric supracondylar humerus fractures: a retrospective cohort analysis

Abstract

Purpose The aim of this study was to analyse the management of displaced paediatric supracondylar humerus fractures at our Level I Trauma Centre and to determine clinical and radiographic long-term results following operative treatment. Methods Clinical and radiological results of 78 paediatric patients (29 female, 49 male; mean age 5.1 years) with supracondylar humerus fractures, treated from 1992 to 2004, were evaluated. Gartland's classification yielded 32 type II, 44 type III and further two flexion injuries. In all patients the follow-up period exceeded 12 months. Assessment after an average of 8.1 years (1.1-19.5) included neurovascular examination, Flynn's criteria (elbow function and carrying angle), pain, complications (infections, growth disturbances or iatrogenic nerve injuries) and measurement of the humeroulnar angle. Results According to Flynn's criteria 73 patients (93.5 %) had a satisfactory outcome, while five (6.4 %) were graded as unsatisfactory (two due to cubitus varus and three because of limited elbow motion). The visual analogue scale (VAS) score averaged 0 (range 0-1) and the mean carrying angle measured 8.4°(−8 to 20°), compared to 10.8°on the contralateral side (2-20°). Injury-related complications yielded absent pulses in four (5.1 %), five (6.4 %) primary median, two (2.6 %) primary radial and one (1.3 %) primary ulnar nerve injury. Treatment-related complications included a secondary displacement and one iatrogenic radial nerve palsy. Based on primary nerve lesion as a dependent variable, statistical analysis showed that age had a significant influence revealing that older paediatric patients had a significantly higher risk (p0 0.02). Functional outcome as a dependent variable revealed an indirect proportion to the clinical carrying angle, achieving statistical significance (p<0.01). Conclusions Crossed pinning in paediatric supracondylar humerus fractures is an effective method. Evaluation of the outcome in our study group demonstrated good results with the treatment approach described.

A comparative study of two closed reduction methods for pediatric supracondylar humeral fractures

“…Even if closed reduction could be achieved in these fractures, maintaining the reduction during percutaneous pinning was exceedingly difficult due to lack of the buttressing effect of the thick anterior periosteum. Some authors [18,19] also believed Gartland type III facture was a independent risk factor for a failed closed reduction. However, all the Gartland type III fractures in Group A and the failed 9 fractures in Group B were all successfully closed reduced by the joystick technique.…”

The displaced supracondylar humerus fracture

“…It is well known that the crossed pin configuration carries the risk of iatrogenic ulnar nerve injury, whereas lateral pinning carries an increased risk of median neuropathy. Overall, incidence rates of iatrogenic ulnar nerve injury range from 0 to 6% [29,[45][46][47][48][49]. Nerve injury occurred at a weighted event rate of 4.1% where crossed pins were used, whereas the use of lateralonly pinning caused neurapraxia at a weighted event rate of 3.4% [44].…”

A study of biplanar crossed pin construct in the management of displaced pediatric supracondylar humeral fractures

“…The treatment of displaced supracondylar fracture of the humerus in children by closed reduction and percutaneous pin fixation has consistently given satisfactory results [6, 7, 19]. A crossed pin construct in the form of a lateral and medial pin fixation method as popularized by Swenson [13] has the advantage of better biomechanical stability, although iatrogenic ulnar nerve injury is possible with the medial pin.…”