Effectiveness of lateral pinning in pediatric supracondylar humerus fractures

Abstract

Introduction: Supracondylar Humerus fractures remain one of the most common fractures in paediatric population, requiring operative management. Closed/open reduction and Percutaneous pinning with K wire, remains the mainstay of treatment for Types 2b and 3 Gartland’s fracture. Despite the hovering controversies, cross pinning remains the most followed technique owing to its higher stability, at the cost of slight increased chances of ulnar nerve injury and harrowing cosmetic outcome. On the other hand, lateral pinning technique provides complete safety against ulnar nerve injury. This study involves functional and radiological outcome assessment of 42 children with Gartland’s Type 2 and 3 fractures who have undergone reduction and k wire fixation via lateral pinning. Methodology: This is a prospective study done in SRIHER from Jan 2016-Sept 2020. All the patients with displaced supracondylar fractures with Gartland’s type 2 and 3 were included. Preop, postop and intraop assessment were done with respect to Ulnar nerve palsy, Baumann’s angle, Flynn criteria till 14 weeks postop. Results: We analyzed a total of 42 pediatric populations (28 male and 14 female) who sustained Gartlands 2 (71%) and 3 (28%) fractures. Among the participants who underwent lateral pinning, 24 patients (57.1%) 2 k wires were used and in 18 patients (42.9%) 3 k-wires were used. Among the lateral pin fixation, 24 (57.1%) participants had divergent pin fixation and 18 (42.9%) participants had parallel pin fixation. Flynn criteria showed good to excellent results, achieved in 34 cases and Fair results were seen in 8 cases. The difference in BA from immediate postop to 6 weeks and 10 weeks after surgery among divergent and parallel pin fixation showed no statistical significance. There was no report of iatrogenic nerve injury in any participants.Conclusion: We suggest lateral pinning technique with the use of 3 divergent pins gives a good stable configuration in supracondylar humerus fractures, also avoiding the risk of ulnar nerve injury.