Meta-Analysis of Pinning in Supracondylar Fracture of the Humerus in Children

Abstract

The purpose of this study was to compare the outcomes of lateral pinning versus cross pinning in pediatric supracondylar humerus fractures. The Cochrane library, MEDLINE, CINAHL, specific orthopaedic journals, abstracts/papers from conferences and meetings, and reference lists of articles were searched from inception to September 2007. All randomized controlled trials and cohort studies comparing outcomes (ie, loss of fixation, iatrogenic ulnar nerve injury, and Flynn criteria) between crossed and lateral pinning were identified. Two authors independently assessed methodological quality and extracted data by using a standardized data extraction form. Heterogeneity among studies was assessed using the Q test. Pooled relative risk was estimated using the Mantel-Haenszel method. Eighteen of 1829 studies were included with 1615 supracondylar fractures (837 and 778 children with cross and lateral pinning, respectively). The average age was 6.1 ± 0.9 years. The risk of iatrogenic ulnar nerve injury was 4.3 (95% confidence interval, 2.1-9.1) times higher in cross pinning compared with lateral pinning. There was no significant difference for loss of fixation, late deformity, or Flynn criteria between the two types of pinning. Lateral pinning is preferable to cross pinning for fixation of pediatric supracondylar humerus fractures as a result of decreased risk of ulnar nerve injury.