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

Erçin, Ersin; Bilgili, Mustafa Gökhan; Baca, Emre; Başaran, Serdar Hakan; Bayrak, Alkan; Kural, Cemal; Avkan, Mustafa Cevdet

doi:10.5505/tjtes.2015.20268

Cited by 10 publications

(12 citation statements)

References 33 publications

(33 reference statements)

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“…A higher rate of iatrogenic ulnar nerve injury in cross pinning was also found by other meta‐analyses 3–8,21 . Cause of injury is multifactorial, including blocking of usual anterior nerve translation, direct penetration and stretching around the medial pin 5,22 . Majority of these resolve with wound exploration and changing position of the medial wire 12 .…”

Section: Discussionmentioning

confidence: 61%

“…Majority of these resolve with wound exploration and changing position of the medial wire 12 . Use of a mini‐open technique, where an incision is made to safeguard the ulnar nerve prior to pin insertion, is thought to be associated with a lower rate of injury 22 . Unlike Patriota et al ., 4 no statistically significant difference was found in iatrogenic ulnar nerve injury when adopting a mini‐open technique with both intention‐to‐treat and treatment‐based analyses.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

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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“…Most of them recover within a few months without requiring additional intervention [3][4][5][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Complication rates can be reduced with decreased flexion of the elbow or as seen of the ulnar nerve by applying a small incision during performing medial pinning [28]. In a meta-analysis performed with 1158 patients, Brauer et al…”

Section: Discussionmentioning

confidence: 99%

Comparison of Three Different Approaches in Pediatric Gartland Type 3 Supracondylar Humerus Fractures Treated With Cross-Pinning

Uludağ

Tosun

Aslan

et al. 2020

Cureus

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Introduction Although closed reduction and percutaneous pinning are the accepted treatment approaches in pediatric humerus supracondylar fractures, the treatment approach in fractures without closed reduction remains unclear. This study compared the results of three different cross-pinning treatment methods. Materials and methods A total of 62 patients (1-13 years old) who were operated for Gartland type 3 humerus supracondylar fractures between 2007 and 2016 were evaluated retrospectively. Of the patients evaluated, 24 patients had closed reduction, 25 patients had direct reduction from the medial, and 13 patients had direct reduction from the lateral and cross-pinning. The functional and cosmetic results of the patients were evaluated according to Flynn's criteria. In addition, the Baumann angle, lateral capitellohumeral angle (LCHA), and postoperative complications were compared among groups.

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“…In our study, the injury occurs in 4.1% of patients in MLP group and 0.9% in LP group, which is similar to previous studies [ 9 , 10 ]. The incidence of ulnar nerve injury in MLP group can be greatly reduced by using a mini-open technique [ 17 , 41 ]. The mini-open technique is to make a small incision at the medial epicondyle and explore the ulnar nerve prior to medial pin placement to avoid nerve injury.…”

Section: Discussionmentioning

confidence: 99%

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

Abstract: BACKGROUND:The present objective was to compare medial mini-open and percutaneous treatment of pediatric supracondylar fractures according to fluoroscopy time, duration of surgery, and iatrogenic ulnar nerve injury.

Cited by 10 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

Comparison of Three Different Approaches in Pediatric Gartland Type 3 Supracondylar Humerus Fractures Treated With Cross-Pinning

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

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