Percutaneous lateral cross-pinning of paediatric supracondylar humeral fractures

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. Patients and methods Thirty-two cases of displaced supracondylar humeral fractures were treated by the closed reduction and lateral cross-pinning technique. The mean age of the patients was 6 years (range; 4-12). All fractures were of the extension type (Gartland's types II and III). Results The mean follow-up period was 12 months (range; 9-20 months). Using the cosmetic and functional criteria of Flynn and colleagues, cosmetically, 93.8% of the cases achieved a satisfactory outcome and 6.2% achieved fair results with mild cubitus varus. Functionally, 87.5% of the cases achieved satisfactory results and 12.5% achieved unsatisfactory results. Radiologically, all fractures united. The humeral shaft-condylar angle was normal in 90.7% and Baumann's angle was normal in all except two cases. There was no case of secondary displacement. Most complications were mild pin-site problems. There were no iatrogenic nerve injuries. Conclusion The lateral cross-pinning technique offers fracture stability and ulnar nerve safety. It could be considered as a viable option for treating displaced supracondylar fractures in children.