A comparative study of cross pinning versus lateral pinning technique in the management of completely displaced type-III supra condylar humerus fracture in the rural India children: A prospective study

Abstract

Context: Supracondylar fractures of the humerus (SCFH) are the most common type of pediatric fracture and related to significant morbidity with the complication of nerve injury and loss of reduction. Closed reduction and percutaneous Kirchner wires pinning either by lateral pin fixation or cross pin fixation for the displaced fractures are the mainstay treatment. Aims: This study has purpose to compare the construct stability, functional, and radiological results between the two methods of fracture fixation. Subjects and Methods: A total of 61 children with Gartland III SCFH were placed randomly into two groups, Group A (n = 30) managed by lateral pinning technique and Group B (n = 31) were managed by cross pinning techniques. Both groups were quite comparable with regard to age, gender, duration of injury, and degree of displacement of the fracture. The results were analyzed in terms of clinical and radiological outcome, Flynn functional scoring system, and complications. Fisher's exact test and unpaired t-tests were used. The results were expressed as mean, and the P < 0.05 was considered statistically significant using the SPSS software (version 22). Results: Statistically, there was no significant difference in clinical or radiological results between the two groups at 6 months after operation (P > 0.05). There was no significant loss of reduction found in either of the groups. There was one (6.6%) case of the lateral pinning group that had a minimal loss of reduction and two (6.4%) cases of the iatrogenic ulnar nerve neuropraxia in the cross pinning group. Neuropraxia recovered fully. Superficial pin tract infection was seen in two (6.67%) cases of the lateral pinning group. Conclusions: Although it appears that cross spinning is a more stable construct, the lateral pin fixation provides the same result without risk of iatrogenic nerve injury with comparable results.