Abstract
BackgroundThe standard treatment for severe displaced pediatric supracondylar humeral fracture (SCHF) is closed reduction and percutaneous pin fixation. However, controversy persists concerning the optimal pin fixation technique. The purpose of this study was to compare the safety and efficacy on the configuration of lateral entry only with crossed entry pin fixation for SCHF, including Gartland type II and type III fractures in children.MethodsPublished literatures, including retrospective studies, prospective studies, and randomized controlled trials, presenting the probability of poor functional consequence of elbow and/or loss of reduction and/or iatrogenic ulnar nerve injury and/or superficial infection and/or cubitus varus were included. Statistical analysis was performed with the Review Manager 5.3 software.ResultsTwenty-four studies were included in the present meta-analysis involving 1163 patients with lateral entry pins and 1059 patients with crossed entry pins. An excellent score of Flynn criteria occurred more commonly in patients who treated with crossed pins than in patients with lateral pins only (RR = 0.93; 95% CI 0.87–0.99; P = 0.03). In accordance with previous systematic review, the incidence of iatrogenic ulnar nerve injury in crossed entry group was significantly more than in lateral entry group with statistical difference (RR = 0.26; 95% CI 0.14–0.47; P < 0.0001). And, results of subgroup analysis on iatrogenic ulnar nerve injury based on experimental design of retrospective study (RR = 0.23; 95% CI 0.10–0.52; P < 0.0004) and randomized control trial (RR = 0.29; 95% CI 0.10–0.79; P < 0.02) were similar.ConclusionsIn consideration of the contradictoriness of lateral entry with two pins only (possible risk of poor functional consequence of elbow) and crossed entry pins (risk of iatrogenic ulnar nerve injury), the recommended strategy for the treatment of SCHF is the lateral entry technique with introducing divergent three pins which can provide a stable configuration and avoid the injury of the ulnar nerve. And additional protective measures for the ulnar nerve should be taken by surgeons that wish for the more stable structure with the crossed entry technique.
Highlights
The standard treatment for severe displaced pediatric supracondylar humeral fracture (SCHF) is closed reduction and percutaneous pin fixation
Inclusion/exclusion criteria Eligible studies in the present meta-analysis were selected according to the following criteria: (1) comparative studies on pinning technique for SCHF with crossed entry and isolated lateral entry; (2) patients of the included studies should be treated with percutaneous pinning after closed reduction, yet a few with a small incision to protect the ulnar nerve were included; and (3) only Gartland type II and type III fractures with percutaneous pin fixation were included
After excluding duplications and screening their titles and abstracts according to the inclusion and exclusion criteria, 24 studies were included in the present meta-analysis involving 1163 patients with lateral entry pins and 1059 patients with crossed entry pins
Summary
The standard treatment for severe displaced pediatric supracondylar humeral fracture (SCHF) is closed reduction and percutaneous pin fixation. The purpose of this study was to compare the safety and efficacy on the configuration of lateral entry only with crossed entry pin fixation for SCHF, including Gartland type II and type III fractures in children. Supracondylar humeral fracture is the most common type of elbow fracture in children younger than 15 years [1]. Agreement has not been reached on the pinning technique and configuration after closed reduction for severely displaced Gartland type II and type III fractures [5]. Crossed entry pins have the advantage of enhanced mechanical stability of the configuration, yet this technique increases the potential injury of the ulnar nerve [7, 8]. Lateral entry pins only may reduce mechanical stability of the structure, ulnar nerve injury can be avoided [9, 10]
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