Conventional versus lateral cross-pinning (Dorgan’s technique) for fixation of displaced pediatric supracondylar humeral fractures: a randomized comparative study

Abstract

Background Although closed reduction and percutaneous pinning is the standard treatment for the displaced pediatric supracondylar humeral fractures, controversy still exists regarding the optimal pin configuration. The aim of this study was to compare the outcomes of the conventional versus lateral cross-pinning (Dorgan’s technique) in treatment of displaced pediatric supracondylar humeral fractures. Patients and methods A total of 50 children were randomly divided into two equal groups: group I (treated via conventional technique) comprised 15 males and 10 female patients, with a mean age of 5.2±2.7 years, and group II (treated via Dorgan’s technique) comprised 17 males and eight female patients, with a mean age of 7.8±3.1 years. Preoperative and postoperative neurologic and radiological evaluations were performed. Functional and cosmetic outcomes were evaluated according to Flynn’s criteria. The mean follow-up periods were 25.24±7.2 and 27.56±6.3 months in groups I and II, respectively. Results There was no statistical significant difference between both groups regarding patients’ and fracture characteristics, postoperative protocol, union time, and complication rate (pin-tract infections and extensive granulation tissue formation around Kirschner wires). The radiological, functional, and cosmetic outcomes were satisfactory in all patients, with no statistically significant difference between both groups. Dorgan’s technique was more time consuming than conventional cross-pinning, with no cases developing any iatrogenic neurological insult in such group; however, iatrogenic transient ulnar nerve injury occurred in one case in group I. Conclusion Both cross-pinning techniques provide a biomechanically stable fixation, allowing early and safe active elbow movements with satisfactory functional, cosmetic, and radiological outcomes, but Dorgan’s method was more time consuming compared with the conventional method. A properly performed Dorgan’s technique completely avoids the risk of iatrogenic ulnar nerve injury without endangering the radial nerve. Level of evidence: level II, randomized comparative study.