Treatment of displaced supracondylar humeral fractures among children: Crossed versus lateral pinning

Zamzam, Mohammed M.; Bakarman, Khalid A.

doi:10.1016/j.injury.2008.10.029

Cited by 49 publications

(45 citation statements)

References 21 publications

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“…Our study also showed the majority of patients with ulnar nerve injuries recovered completely during followup. For loss of reduction and deformity, inconsistent results were reported in previous studies [5,9,37,39,48,50,59]. Skaggs et al [50] retrospectively reviewed the results of reduction and pin fixation of 345 extension-type supracondylar fractures in children and found there was no difference regarding maintenance of fracture reduction between the crossed pins and the lateral pins.…”

Section: Discussionmentioning

confidence: 98%

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other surgical complications caused by pin fixation.Methods We searched PubMed, Embase, the Cochrane Library, and other unpublished studies without language restriction.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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Section: Discussionmentioning

confidence: 98%

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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“…The incidence of reported iatrogenic ulnar nerve lesions with a medial pin ranges from 1.4% to 15.6% (16,(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

“…(b) the ulnar nerve is palpated and pushed posteriorly with thumb before inserting the medial pin (c) a small separate incision over the medial epicondyle to explore the ulnar nerve is required, if there is gross swelling (8,16,22,24).…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Three Percutaneous Pinning Techniques for Paediatric Supracondylar Humeral Fractures

2017

ARC Journal of Orthopedics

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“…Placement of a medial KW and the risk of an ulnar nerve injury have been at the center of the debate and remain controversial. Although a medial KW may improve stability, it also increases the risk of iatrogenic ulnar nerve injury, with the reported incidence of post-operative ulnar nerve injury ranging from 0 to 15 % [1,5,9,11]. In their recent review of the literature, Slobogean et al concluded that when compared with lateral entry KW, the crossed KW configuration is associated with an increased risk of injuring the ulnar nerve [4].…”

Section: Introductionmentioning

confidence: 99%

“…Sankar et al [15] found that the two-lateral KW configuration was more often associated with a loss of reduction, while no loss of reduction occurred with the crossed KW configuration. Zamzam and Bakarman [11] suggest that a medial KW should often be added, based on intra-operative assessment of fracture stability. Kocher et al [9] found both configurations to be effective in the treatment of SCHF.…”

Section: Introductionmentioning

confidence: 99%

Pediatric supracondylar humerus fractures: Effect of bone–implant interface conditions on fracture stability

Lamdan

Liebergall

Gefen

et al. 2013

Journal of Children's Orthopaedics

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Background Closed reduction and percutaneous fixation with Kirschner wires (KWs) is the standard of care of pediatric supra-condylar humerus fractures (SCHFs). Failure modes leading to loss of reduction are not clear and have not been quantified. Multiple factors may weaken the KW-bone interface bonding conditions. To the best of our knowledge, the possible effect of this decrease on different KW configurations and fracture stability has never been studied. Purpose To investigate the effect of bone-KW friction conditions on SCHF post-operative mechanical stability and to formulate clinical guidelines for KW configuration under different conditions. Methods Finite element-based model of a fixated SCHF was used to simulate structure stability for two lateral divergent versus crossed lateral and medial KW configurations under varying KW-bone friction conditions. Results Finite element simulations demonstrated that crossed KWs provide superior stability compared with the divergent configuration when KW-bone bonding is compromised. When KW-bone bonding conditions are adequate, crossed and divergent KW configurations provide similar, sufficient fracture stability. Conclusions Under normal bone-implant interface conditions, the two diverging lateral KW configuration offers satisfactory mechanical stability and may be the preferred choice of SCHF fixation. When KW-bone bonding is suboptimal, as when one or more of the lateral KWs are redrilled, addition of a medial KW should be considered in order to improve stability despite risk to ulnar nerve.

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Treatment of displaced supracondylar humeral fractures among children: Crossed versus lateral pinning

Cited by 49 publications

References 21 publications

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

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

A Comparative Study of Three Percutaneous Pinning Techniques for Paediatric Supracondylar Humeral Fractures

Pediatric supracondylar humerus fractures: Effect of bone–implant interface conditions on fracture stability

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