Use of lateral-exit crossed-pin fixation for pediatric supracondylar humeral fractures: a retrospective case series

Abstract

Surgeons have been reluctant to perform crossed-pin fixation for displaced pediatric supracondylar humeral (SCH) fractures because it carries a risk of iatrogenic ulnar nerve injury. This study aimed to introduce lateralexit crossed-pin fixation for displaced pediatric SCH fractures and to evaluate its clinical and radiological outcomes, with a particular focus on iatrogenic ulnar nerve injuries. Children who underwent lateral-exit crossed-pin fixation for displaced SCH fractures between 2010 and 2015 were retrospectively reviewed. Lateral-exit crossedpin fixation involved the introduction of a medial pin from the medial epicondyle, as in the conventional method, followed by pulling the pin through the lateral skin until the distal and medial aspects of the pin were just under the cortex of the medial epicondyle. The time to union and loss of fixation were assessed. Flynn's clinical criteria (cosmetic and functional factors) and complications including iatrogenic ulnar nerve injury were investigated. A total of 81 children with displaced SCH fractures were treated with lateral-exit crossed-pin fixation. All but one patient achieved union with good alignment, with an average time to union of 7.9 weeks (3.9-10.3 weeks). Only one patient exhibited cubitus varus deformity associated with loss of reduction. All patients recovered to almost their full range of motion. No case of iatrogenic ulnar nerve injury developed; however, iatrogenic radial nerve injury developed in one patient. Lateral-exit crossed-pin fixation provides sufficient stability with a lower risk of iatrogenic ulnar nerve injury in children with displaced SCH fractures. This method is an acceptable technique for crossed-pin fixation.

Use of lateral-exit crossed-pin fixation for pediatric supracondylar humeral fractures: a retrospective case series

“…Yun et al [1] reported a radial nerve injury incidence of 1.2%, which is by far higher than that reported by Babal et al [3] of 0.12% for crossed-pin-and 0.63% for lateral-pin fixation.…”

“…We read with interest the publication by Yun and colleagues [1]. Yun et al [1] stated that surgeons have been reluctant to perform crossed-pin fixation for displaced pediatric supracondylar humeral fractures (SCH), but this is not supported by Pavone et al's [2] recent European survey.…”

“…We read with interest the publication by Yun and colleagues [1]. Yun et al [1] stated that surgeons have been reluctant to perform crossed-pin fixation for displaced pediatric supracondylar humeral fractures (SCH), but this is not supported by Pavone et al's [2] recent European survey. The latter stated that out of 156 pediatric orthopedic surgeons who reported their preferred pin configuration for Gartland III fractures, 91 used crossed-and 65 lateral only pin fixations.…”

“…Yun et al [1] evaluated the degree of loss of reduction of Baumann's angle, using Skaggs et al's method [8]. However, the latter has been shown to be inaccurate [9], because it is based on a large data transcription error made by Camp et al [10] in their original paper on the alteration of Baumann's angle, which was not recognized by Skaggs et al [8], resulting in the latter authors defining a meaningful difference incorrectly as ≥12° instead of ≥3.2°.…”

“…However, the latter has been shown to be inaccurate [9], because it is based on a large data transcription error made by Camp et al [10] in their original paper on the alteration of Baumann's angle, which was not recognized by Skaggs et al [8], resulting in the latter authors defining a meaningful difference incorrectly as ≥12° instead of ≥3.2°. Using Skaggs et al's method [8] would result in some deformities being defined as no deformity and therefore, Yun et al [1] do not know if their technique 'may provide adequate stability'. [1] 81 patients had persistent instability after insertion of 2 lateral K-wires.…”