Comparison of Fixation of supracondylar humeral fractures in children by lateral cross-wiring technique versus traditional lateral pinning

Abstract

Introduction The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The aim of this study was to study the results of a cross-wiring technique, achieved solely from the lateral side, in an effort to reduce the risk of ulnar nerve injury. Conclusion there was no significant difference between lateral cross-wiring technique and traditional lateral pinning as regard postoperative clinical results and radiological results. Introduction Supracondylar fractures of the humerus in children accounts for 60% of all fractures around the elbow. (1) It represents 4 - 6.5% of all paediatric fractures. In treatment of non-displaced Type I fractures simple immobilization with a posterior splint applied at 60-90o of elbow flexion is preferred. (2) Currently, the treatment of choice for type II fractures is operative reduction and pinning rather than cast. (3) Most cases of type III fractures require operative reduction and pinning. The results of type III fractures treated with closed reduction and cast immobilization are not as good as the results of pinning. (4) There are various options for the pattern of K-wire fixation of displaced supracondylar fractures. Studies found the greatest resistance to rotation occurred with medial-lateral cross pinning. (5) The second most stable pattern was fixation utilizing three lateral diverging pins. The least stable was fixation with two lateral pins, which cross at the fracture site. While medial-lateral cross pinning has the greatest resistance; the disadvantage is the risk of ulnar nerve injury. (6) Lateral pinning is recommended (7) to avoid iatrogenic ulnar nerve injury that can occur with medial lateral cross pinning. Although iatrogenic ulnar nerve injuries usually resolve, several permanent iatrogenic ulnar nerve injuries have been described. (8) Closed reduction and lateral cross-wiring technique with ascending and descending K-wires is an effective method to treat type II and III supracondylar fractures in children. Regardless of stability, this method can be used to avoid iatrogenic ulnar nerve injuries. (9) Aim of the work The aim of this work is to assess clinical results of fixation of supracondylar humeral fractures by lateral cross-pinning versus traditional lateral pinning in children.