Meta-Analysis of Pinning in Supracondylar Fracture of the Humerus in Children

Woratanarat, Patarawan; Angsanuntsukh, Chanika; Rattanasiri, Sasivimol; Attia, John; Woratanarat, Thira; Thakkinstian, Ammarin

doi:10.1097/bot.0b013e3182143de0

Cited by 92 publications

(86 citation statements)

References 29 publications

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“…The patient's age at the time of fracture was also equally similar: 5.9 years (2,4,(26)(27)(28)(29) . The development of compartment syndrome is the most feared complication of this type of injury.…”

Section: Discussionmentioning

confidence: 83%

“…Cubitus varus is considered the most common late complication in this type of fracture, presenting an incidence of 20% in our series. Other authors who used closed reduction and percutaneous fixation reported lower rates of around 10% (1,(3)(4)(5)(6)(14)(15)(16)(17)(18)22,25,(27)(28)(29) . The initial deviation and ligamentotaxis are the main factors mechanically influencing the final result of the fracture.…”

Section: Discussionmentioning

confidence: 99%

“…The development of compartment syndrome is the most feared complication of this type of injury. Nerve injuries, such as neuropraxia, are relatively common, accounting for between 6 and 16% of all complications (2,3,(26)(27)(28)(29) . Lesion of the ulnar nerve, although rare (4.3%), is usually reversible, and is most commonly related to untimely treatment and edema in the region, which makes it difficult to feel and identify the anatomical accidents.…”

Section: Discussionmentioning

confidence: 99%

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Fratura supracondiliana de úmero em crianças: fixação com dois fios de Kirschner cruzados

Carvalho¹,

Filho²,

Neto³

et al. 2012

Rev. bras. ortop.

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Objective: To analyze and present the surgical results from unstable supracondylar fractures of the humerus in children, treated by means of reduction and percutaneous fixation using two crossed Kirschner wires. Methods: A cross-sectional study was conducted on 20 children, taking into consideration sex, age at the time of the fracture, age at the time of the assessment, side affected, type and mechanism of trauma, postoperative complications and radiographic and clinic variables. Results: Ten fractures were observed in the left arm and ten in the right arm. The age at the time of the fracture ranged from 2 to 13 years (mean: 5.9 ± 2.48 years). Three fractures were classified as type II and 17 as type III. The length of follow-up ranged from four months to three years. Baumann's angle ranged from 69 to 100 (mean: 78.3) and cubitus varus was observed in four patients (values ranging from 84 to 100). According to the modified Flynn's criteria, 20 cases presented satisfactory outcomes: 17 excellent (85%), two good (10%) and one regular (5%). Two patients presented limited range of motion, two had paresthesia in the cubital region and one had transient neuropraxia of the ulnar nerve for six weeks. Conclusion: Percutaneous fixation with two crossed Kirschner wires leads to good results when carried out under direct viewing and with isolation of the ulnar nerve.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fratura supracondiliana de úmero em crianças: fixação com dois fios de Kirschner cruzados

Carvalho¹,

Filho²,

Neto³

et al. 2012

Rev. bras. ortop.

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“…Few meta-analyses or systematic reviews compared the postoperative functional outcomes. Woratanarat et al [57] performed a meta-analysis to compare the criteria of Flynn et al for the two pin fixation techniques, but there were insufficient RCTs to pool data until September 2007. The current meta-analysis included three studies which reported the criteria of Flynn et al Further, no major differences were found concerning the outcomes between the lateral entry pin and crossed entry pin in our meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Although several meta-analyses or systematic reviews of lateral entry versus crossed medial and lateral entry pinning for supracondylar fractures of the humerus have been reported [3,5,29,38,52,57], the conclusions drawn are based largely on results from nonrandomized controlled trials (nRCTs), which increases the likelihood that bias has affected those analyses. Randomized controlled trials (RCTs) are considered to be the most reliable form of scientific evidence in the hierarchy of evidence because they reduce spurious inferences of causality and bias.…”

Section: Introductionmentioning

confidence: 99%

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

Zhao

Wang

Zhang

2013

Clinical Orthopaedics &Amp; Related Research

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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.

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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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Meta-Analysis of Pinning in Supracondylar Fracture of the Humerus in Children

Abstract: Lateral pinning is preferable to cross pinning for fixation of pediatric supracondylar humerus fractures as a result of decreased risk of ulnar nerve injury.

Cited by 92 publications

References 29 publications

Fratura supracondiliana de úmero em crianças: fixação com dois fios de Kirschner cruzados

Fratura supracondiliana de úmero em crianças: fixação com dois fios de Kirschner cruzados

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

Interventions for treating supracondylar elbow fractures in children

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