Is Lateral Pin Fixation for Displaced Supracondylar Fractures of the Humerus Better Than Crossed Pins in Children?

Abstract

Background Closed reduction and percutaneous pin fixation is considered standard management for displaced supracondylar fractures of the humerus in children. However, controversy exists regarding whether to use an isolated lateral entry or a crossed medial and lateral pinning technique. Questions/purposes We performed a meta-analysis of randomized controlled trials (RCTs) to compare (1) the risk of iatrogenic ulnar nerve injury caused by pin fixation, (2) the quality of fracture reduction in terms of the radiographic outcomes, and (3) function in terms of criteria of Flynn et al. and elbow ROM, and other surgical complications caused by pin fixation.Methods We searched PubMed, Embase, the Cochrane Library, and other unpublished studies without language restriction. Seven RCTs involving 521 patients were included. Two authors independently assessed the methodologic quality of the included studies with use of the Detsky score. The median Detsky quality score of the included trials was 15.7 points. Dichotomous variables were presented as risk ratios (RRs) or risk difference with 95% confidence intervals (CIs) and continuous data were measured as mean differences with 95% CI. Statistical heterogeneity between studies was formally tested with standard chi-square test and I 2 statistic. For the primary objective, a funnel plot of the primary end point and Egger's test were performed to detect publication bias. Results The pooled RR suggested that iatrogenic ulnar nerve injury was higher with the crossed pinning technique than with the lateral entry technique (RR, 0.30; 95% CI,. No publication bias was further detected. There were no statistical differences in radiographic outcomes, function, and other surgical complications. No significant heterogeneity was found in these pooled results. Conclusions We conclude that the crossed pinning fixation is more at risk for iatrogenic ulnar nerve injury than the lateral pinning technique. Therefore, we recommend the lateral pinning technique for supracondylar fractures of the humerus in children.

Surgical Treatment of Displaced Supracondylar Pediatric Humerus Fractures: Comparison of Two Pinning Techniques

“…For this reason, this configuration has been employed for several years and guaranteed higher stability. However, Slobogean et al [12] reported that the cross-wired configuration leads to an increased risk of iatrogenic damage to the ulnar nerve versus a lateral K-wire [25].…”

The displaced supracondylar humerus fracture

“…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]. Similarly, a recent meta-analysis of randomized controlled trials by Zhao et al [51] supported the assertion that iatrogenic ulnar nerve injury was higher with the crossed pinning technique than with the lateral entry technique. In a systematic review by Slobogean et al [50], the number needed to harm for ulnar nerve injury was reported to be 28 in crossed pinning.…”

Medial mini-open versus percutaneous pin fixation for type 3 supracondylar fractures in children

“…[10,19] In a meta-analysis of randomized controlled trials, crossedpinning fixation was determined to carry greater risk of iatrogenic ulnar nerve injury than lateral pinning, and the later technique was recommended. [20] In a single retrospective cohort study that included 65 patients (29 Gartland type III and 36 Gartland type II fractures), authors reported 1 iatrogenic ulnar nerve injury and recommended crossed-pin fixation with mini-open technique as a safe and reliable method. [4] The present is the first study to compare medial mini-open crossed-pinning and percutaneous crossed-pinning techniques.…”