Various techniques for fixation of pediatric supracondylar humerus fracture have been in practice, but which is a better option is still controversial.
Eswaran Mythilisri et al conducted a study to compare the functional and radiological outcomes of pediatric supracondylar humerus fracture fixed by percutaneous cross-pinning or lateral pinning.
The authors conducted a prospective, single-blinded, randomized control trial with 60 patients divided into two groups of 30 each, ages ranging from less than one year to 13 years, with Gartland type 2 or 3 supracondylar humerus fractures.The outcome of fracture fixation treated with either crossed or lateral pinning was assessed with a six-month follow-up by comparing the pre-operative and post-operative Baumann angle, post-operative carrying angle and the Flynn criteria.
The key findings of the study were:
• The age range was 3–9 years in both groups.
• Gartland type 3 supracondylar humerus fracture was most commonly noted in group A (19 patients) and type 2 fracture was noted more commonly in group B (16 patients).
• There was no significant difference in the radiological outcome of the supracondylar humerus fracture fixed with percutaneous cross-pinning or lateral pinning.
• No patient had any iatrogenic ulnar nerve injury.
• All 60 patients had excellent Flynn criteria at the end of the six-month follow-up.
The authors concluded – “both the techniques of percutaneous pinning, i.e., cross-pinning and lateral-pinning, showed comparable bony union. However, the functional outcomes were better at 3 months follow-up in the lateral-pinning group compared to cross-pinning. Nonetheless, at 6 months after surgery there were no differences in the outcomes in both the groups. Though the duration of surgery was not statistically significant between the groups, cross-pinning group was found have a longer time for fracture fixation. The trans-olecranon technique of fixation can be adopted as it has been shown to provide superior stability with four cortical purchases. However, more research on this technique is warranted.”
Further reading:
Comparison of Crossed Versus Lateral Pinning in Fixation of Extension Type of Supracondylar Humerus Fracture in Pediatric Age Group- A Randomized Control Trial
Eswaran Mythilisri et al
Indian Journal of Orthopaedics (2025) 59:1553–1562
https://doi.org/10.1007/s43465-025-01454-x
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