Comparison of Lateral Pinning and Cross Pinning Results in Pediatric Distal Humerus Supracondylar Gartland Type 3 Fractures

Yıl 2021, Cilt: 2 Sayı: 3, 177 - 181, 22.09.2021

Muhammet Salih Ayas , Kerim Öner

Öz

Background: In this study, we aimed to evaluate the functional outcomes and complications of Gartland type 3 patients treated with lateral pinning and cross pinning in children aged between five and ten years.

Methods: Seventy-four fractures participated in the study, and the data were analyzed. Patients in the lateral pinning group (n:41) were treated with the lateral entry pin alone, and patients in the cross pinning group (n:33) were treated with a combination of 2 lateral entry pins and one medial entry pin. Age, gender, fractured side, Vong Baker pain scale score, duration of surgery, postoperative complications, surgical approach, direction of pin application (lateral or cross), and Modified Flynn grading system grade was noted.

Results: No statistically significant difference was found between lateral pinning and crossed pinning groups in terms of the grade of the Modified Flynn grading system and complications (iatrogenic ulnar nerve damage, loss of reduction, and superficial infection) (respectively, p: 0.138 and p: 0.991).

Conclusion: When both techniques were performed carefully, successful clinical results were observed. If the surgeon detects intraoperative instability, s/he should not hesitate to pin the medial K-wire in order to increase stability.

Anahtar Kelimeler

Pediatric Fractures, Supracondylar Humerus Fractures, Cross Pinning, Lateral Pinning.

Kaynakça

• 1. Kwiatkowska M, Dhinsa BS, Mahapatra AN. Does the surgery time affect the final outcome of type III supracondylar humeral fractures? J Clin Orthop Trauma. 2018;9(Suppl 1):S112–5.
• 2. Mallo G, Stanat SJC, Gaffney J. Use of the gartland classification system for treatment of pediatric supracondylar humerus fractures. Orthopedics. 2010;33(1):19.
• 3. Vaquero-Picado A, González-Morán G, Moraleda L. Management of supracondylar fractures of the humerus in children. EFORT Open Rev. 2018;3(10):526-540.
• 4. Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am. 2008;90(5):1121-32.
• 5. Abbott MD, Buchler L, Loder RT, Caltoum CB. Gartland type III supracondylar humerus fractures: outcome and complications as related to operative timing and pin configuration. J Child Orthop. 2014;8(6):473–7.
• 6. Mostafavi HR, Spero C. Crossed pin fixation of displaced supracondylar humerus fractures in children. Clin Orthop Relat Res. 2000;(376):56-61.
• 7. Lee YH, Lee SK, Kim BS, Chung MS, Baek GH, Gong HS, et al. Three lateral divergent or parallel pin fixations for the treatment of displaced supracondylar humerus fractures in children. J Pediatr Orthop. 2008;28(4):417–22.
• 8. Otsuka NY, Kasser JR. Supracondylar Fractures of the Humerus in Children. J Am Acad Orthop Surg. 1997;5(1):19–26.
• 9. Lyons JP, Ashley E, Hoffer MM. Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop. 1998;18(1):43–5.
• 10. Blanco JS. Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop. 1998;18(6):824.
• 11. Na Y, Bai R, Zhao Z, Han C, Kong L, Ren Y, et al. Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: A meta-analysis. J Orthop Surg Res. 2018;13(1).
• 12. Larson L, Firoozbakhsh K, Passarelli R, Bosch P. Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. J Pediatr Orthop. 2006;26(5):573–8.
• 13. Lee SS, Mahar AT, Miesen D, Newton PO. Displaced pediatric supracondylar humerus fractures: Biomechanical analysis of percutaneous pinning techniques. J Pediatr Orthop. 2002;22(4):440–3.
• 14. Slobogean BL, Jackman H, Tennant S, Z Gerard PS, Mulpuri K. Iatrogenic ulnar nerve injury after the surgical treatment of displaced supracondylar fractures of the humerus: Number needed to harm, a systematic review. J Pediatr Orthop. 2010;30(5):430–6.
• 15. Garra G, Singer AJ, Taira BR, Chohan J, Cardoz H, Chisena E, et al. Validation of the Wong-Baker FACES pain rating scale in pediatric emergency department patients. Acad Emerg Med. 2010;17(1):50–4.
• 16. Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg Am. 1974;56(2):263-72.
• 17. Kang S, Kam M, Miraj F, Park SS. The prognostic value of the fracture level in the treatment of Gartland type III supracondylar humeral fracture in children. Bone Joint J. 2015;97-B(1):134-40.
• 18. Boyd DW, Aronson DD. Supracondylar fractures of the humerus: A prospective study of percutaneous pinning. J Pediatr Orthop. 1992;12(6):789–94.
• 19. Zionts LE, Woodson CJ, Manjra N, Zalavras C. Time of return of elbow motion after percutaneous pinning of pediatric supracondylar humerus fractures. Clin Orthop Relat Res. 2009;467(8):2007–10.
• 20. Kumar V, Singh A. Fracture supracondylar humerus: A review. J Clin Diagnostic Res. 2016;10(12):1–6.
• 21. Hamdi A, Poitras P, Louati H, Dagenais S, Masquijo JJ, Kontio K. Biomechanical analysis of lateral pin placements for pediatric supracondylar humerus fractures. J Pediatr Orthop. 2010;30(2):135–9.
• 22. Swenson AL. The treatment of supracondylar fractures of the humerus by Kirschner-wire transfixion. J Bone Joint Surg Am. 1948;30(4):993–7.
• 23. Brown IC, Zinar DM. Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop. 1995;15(4):440–3.
• 24. Royce RO, Dutkowsky JP, Kasser JR, Rand FR. Neurologic complications after k-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop. 1991;11(2):191–4.
• 25. Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am. 2001;83(5):735-40.
• 26. Kwak-Lee J, Kim R, Ebramzadeh E, Silva M. Is medial pin use safe for treating pediatric supracondylar humerus fractures? J Orthop Trauma. 2014;28(4):216–21.
• 27. Maity A, Saha D, Roy DS. A prospective randomised, controlled clinical trial comparing medial and lateral entry pinning with lateral entry pinning for percutaneous fixation of displaced extension type supracondylar fractures of the humerus in children. J Orthop Surg Res. 2012;7(1).