Crossed Wires Versus 2 Lateral Wires in Management of Supracondylar Fracture of the Humerus in Children in the Hands of Junior Trainees

Karim, Mahmoud Abdel; Hosny, Ahmed; Abdelatif, Nasef Mohamed Nasef; Hegazy, Mohamed; Awadallah, Walid R.; Khaled, Sherif A.; Azab, Mostafa A.; Elnahal, Walid A.; Mohammady, Hany

doi:10.1097/bot.0000000000000473

Cited by 23 publications

(26 citation statements)

References 19 publications

(17 reference statements)

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“…However, the crossed entry fixation method has been shown to have a higher risk of iatrogenic ulnar nerve injury than the lateral entry method [ 43 ]. Some studies reported that the risk of iatrogenic ulnar nerve injury could be greatly reduced through the placement of a medial pin with a medial mini-incision on the medial epicondyle and the extension of the elbow [ 8 , 26 , 31 , 33 ]. The risk of iatrogenic ulnar nerve injury associated with medial pin entry could be resolved after wound exploration and placement of the medial pin at a new location.…”

Section: Discussionmentioning

confidence: 99%

“…In four studies in which children with SCHF were treated with crossed pinning with a mini-open incision [ 8 , 26 , 31 , 33 ], the risk of iatrogenic ulnar nerve injury between the children treated with lateral pinning entry and the children treated with crossed pinning with mini-open incisions was not different (RR = 1.58, 95% CI 0.008–29.57, P = 0.76) (Fig. 4 B).…”

Section: Methodsmentioning

confidence: 99%

“…Four studies [ 26 , 29 , 31 , 33 ] reported the incidence of pin infections. In the crossed pins group, nine (5.3%) of 169 patients had infections, whereas 10 (6.0%) of 168 patients in the lateral entry group had infections.…”

Section: Methodsmentioning

confidence: 99%

“…Iatrogenic ulnar nerve injury Iatrogenic ulnar nerve injury was one of the most common problems, reported in 11 of the 12 studies [8,[26][27][28][29][30][31][32][33][34]. The data were pooled across 11 studies, and the analysis revealed a significant difference in the pooled treatment effect with no heterogeneity (P = 0.79, I 2 = 0%).…”

Section: Effects Of Interventionsmentioning

confidence: 99%

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Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials

Zhao

Liu

et al. 2021

J Orthop Surg Res

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Background Closed reduction and pinning entry fixation have been proposed as treatment strategies for displaced supracondylar humeral fractures (SCHFs) in children. However, controversy exists regarding the selection of the appropriate procedure. Hence, this meta-analysis was conducted to compare the effect of lateral and crossed pin fixation for pediatric SCHFs, providing a reference for clinical treatment. Methods Online databases were systematically searched for randomized controlled trials (RCTs) comparing lateral pinning entry and crossed pinning entry for children with SCHFs. The primary endpoints were iatrogenic ulnar nerve injuries, complications, and radiographic and functional outcomes. Results Our results showed that iatrogenic ulnar nerve injuries occurred more commonly in the crossed pinning entry group than in the lateral pinning entry group (RR = 4.41, 95% CI 1.97–9.86, P < 0.05). However, its risk between the crossed pinning with mini-open incisions group and the lateral pinning entry group was not significantly different (RR = 1.58, 95% CI 0.008–29.57, P = 0.76). The loss of reduction risk was higher in the lateral pinning entry group than in the crossed pinning entry group (RR = 0.66; 95% CI 0.49–0.89, P < 0.05). There were no significant differences in the carry angle, Baumann angle, Flynn scores, infections, and other complications between these two groups. Conclusions The crossed pinning entry with mini-open incision technique reduced the loss of reduction risk, and the risk of iatrogenic ulnar nerve injury was lower than in the lateral pinning entry group. The crossed pinning entry with mini-open incision technique is an effective therapeutic strategy for managing displaced supracondylar humeral fractures in children.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Effects Of Interventionsmentioning

confidence: 99%

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Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials

Zhao

Liu

et al. 2021

J Orthop Surg Res

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“…Crossed-pin constructs were significantly more stable in extension, internal rotation, and external rotation, as well as more stable compared with both lateral pin constructs. In a single-center, prospective randomized controlled trial, Abdel Karim et al [ 20 ] assigned 60 pediatric patients with operatively treated SCH fractures to receive either 2 lateral pin constructs or a 2 crossed-pin construct. The authors found a significantly higher rate of reduction loss when using 2 lateral pins (20%) compared with 2 crossed pins (0%) ( P = .031).…”

Section: Discussionmentioning

confidence: 99%

Sagittal plane alignment affects the strength of pin fixation in supracondylar humerus fractures

Bitzer¹,

Belkoff²,

LiBrizzi³

et al. 2021

Medicine

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Closed reduction with percutaneous pin fixation is commonly used to treat pediatric supracondylar humerus fractures. Various pin configurations of varying biomechanical strength have been described. However, to our knowledge, no biomechanical study has focused on pin alignment in the sagittal plane. Our goal was to compare the stability of fixation using 3 different pin constructs: 3 lateral pins diverging in the coronal plane but parallel in the sagittal plane (3LDP), 3 lateral pins diverging in the coronal and sagittal planes (3LDD), and 2 crossed pins (1 medial and 1 lateral). Transverse fractures were made through the olecranon fossa of 48 synthetic humeri, which were then reduced and pinned in the 3LDP, 3LDD, and crossed-pin configurations (16 specimens per group) using 1.6-mm Kirschner wires. The sagittal plane pin spread was significantly greater in the 3LDD group than in the 3LDP group, whereas we found no difference in the coronal plane. Sagittal extension testing was performed from 0° to 20° at 1°/s for 10 cycles using a mechanical torque stand. The torque required to extend the distal fragment 20° from neutral was compared between groups using one-way analysis of variance with multiple comparison post-hoc analysis. P values ≤.05 were considered significant. The 3LDD configuration was more stable than the 3LDP and crossed-pin configurations. The mean torque required to displace the pinned fractures was 5.7 Nm in the 3LDD group versus 4.1 Nm in the 3LDP group and 3.7 Nm in the crossed-pin group (both, P < .01). We found no difference in stability between the 3LDP and crossed-pin groups ( P = .45). In a synthetic biomechanical model of supracondylar humerus fracture, sagittal alignment influenced pin construct stability, and greater pin spread in the sagittal plane increased construct stability when using 3 lateral pins. The lateral pin configurations were superior in stability to the crossed-pin configuration. Level of Evidence: Level V.

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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 Wires Versus 2 Lateral Wires in Management of Supracondylar Fracture of the Humerus in Children in the Hands of Junior Trainees

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 23 publications

References 19 publications

Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials

Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials

Sagittal plane alignment affects the strength of pin fixation in supracondylar humerus fractures

Interventions for treating supracondylar elbow fractures in children

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