Percutaneous Cross-pinning Research Articles

Humerus Supracondylar Fracture in Children Treated with Closed Redution Percutaneous Cross Pinning vs Two Lateral Pinning

Objective: With this research, we hope that we can compare the effectiveness of percutaneous cross pins in treating paediatric supracondylar humerus fractures to that of two-lateral pins. Study Design: Prospective study Place and Duration: Children Hospital Faisalabad/ Bahawal Victoria Hospital Bahawalpur.April 2018-Oct 2018. Methods: This research included 104 patients of both sexes. After permission, the patient's age, sex, and BMI were recorded. The patients ranged in age from 3 to 10. Children with supracondylar humerus fractures were split into two groups. Percutaneous cross pinning was performed on group C patients, whereas two lateral pinning was done on group D patients. We examined the radiological and functional results and the occurrence of problems between the two groups. SPSS 21.0 was used to analyze the data. Results: In current study surgical time in group C was lower as compared to group D and had higher radiation time with p value <0.003. Post operatively frequency of excellent results in group C was higher among 35 (67.3%) cases as compared to group D in 27 (51.9%) patients. Frequency of poor results in group D was higher in 5 (9.6%) patients as compared to group C in 1 (1.9%) cases. Complication rate was also higher in group D 12 (23.1%) patients as compared to group C in only 6 (11.5%) cases. Conclusion: We observed that percutaneous pinning was more advantageous than two lateral pinnings in treating children with closed reduction supracondylar humerus fractures. Keywords: Children Percutaneous cross pinning, supracondylar humerus fracture,Two lateral pinning

Efficacy of Closed Reduction Perutaneous Pinning and Laeral Pinning in the Treatment of Supracndylar Fracture of Humerus in Children

Objective: Closed reduction percutaneous cross pinning vs. lateral pinning in the treatment of children's supracondylar humeral fractures is the goal of this research. Study Design: Prospective study Place and Duration: THQ hospital Jaranwala/ Punjab medical college Faisalabad. Feb 2021-Aug 2021 Methods: This research included a total of 90 patients of both sexes. After obtaining informed permission, demographic information such as gender, age, and BMI was gathered. Patients ranging in age from 2 to 15 years old were taken into consideration for treatment. Two groups of children with fractures of the supracondylar humerus were recruited and randomized. In the first group, 45 patients got percutaneous cross pinning, whereas in the second group, 45 patients had lateral pinning performed on them. Both groups' radiological and functional outcomes were evaluated using Flynn's criteria, and a high incidence of problems was noted. SPSS 24.0 was used to analyze all of the data. Results: Total 60 (66.7%) patients were males and 30 (33.3%) cases were females. There was no any significant difference of age among both groups. Most common cause of fracture was sports and road traffic accident. In group I mean surgical time was 28.12±4.04 minutes and mean time in group II was 32.21±4.31 minutes. We found mean radiation time in group I was greater 4.11±5.41 sec than in group II radiation time was 3.21±4.5 sec. According to Flynn's criteria, excellent results were found in 29 (64.4 %) cases, good results were found in 10 (22.2 %), and fair results were found in 6 (13.3 %) cases in group I, while excellent results were found in 24 (53.3 %) cases, good results were found in 13 (28.9 %), and fair results were found in 8 (17.8%) cases in group II. Conclusion: After conducting this study, we came to the conclusion that both methods for the treatment of closed reduction supracondyla fractures of the humerus are safe and effective for children; however, percutaneous pining was found to be less operative and required more radiation time than two lateral pinnings. Keywords: Two lateral pinning, Children, Supracondylar humerus fracture, Percutaneous cross pinning

A Comparative Study to Determine the Outcome of Supracondylar Fracture of Humerus in Children Treated with Percutaneous Cross Pinning Versus Two Lateral Pinning

Objective: Analysis and assessment of anatomical refurbishment with the use of percutaneous cross pinning versus two lateral pinning and to determine the functional consequences of these procedures, to evaluate the hurdles faced in these treatment methodologies, and the comparison between the patient acceptances in both methods. Methods: This research was a comparative cross-sectional analysis which was conducted at Orthopedics department of Ayub Teaching Hospital Abbottabad for duration of six months i.e from March 2021 to August 2021. The sample size for the research was 50 patients who were admitted both at the (outpatient department) OPD and in the emergency ward. All the patients were clinically examined carefully and thoroughly, and all of their details were recorded. Base line investigations and X-rays were performed of every patient. Results: Percutaneous cross pinning or two lateral pinning methods were used to treat 50 patients suffering from supra-condylar fracture of humerus. Two groups were formed, each had 25 patients. Group A consisted of patients were treated from PCP, while group B patients were treated from TLP. Among the patients of Group, A, 20(80%) were male, 5(20%) were female, with a female: male ratio of 1:5, while in group B patients, 22(88%) were male, 3(8%) were female, with a female: male ratio of 1:8. The average age of both the groups was 7.30+3.30 years. The most prominent reason of fracture in the designed study was fall during playing (54%), 24% patients reported falling from bicycle, while only 22% patients had fallen from trees, the height of which was around 5-7 feet. Postero-medial displacement was observed in 66% patients, while Postero-lateral displacement was observed in 34% patients. Among the list of complications, in TLP, 8% patients suffered from superficial pin tract infection, 12% patients suffered from non-union, and 4% patients had K-wire migration and 4% had Cubitus varus. On the other hand, in PCP group patients, one patient developed superficial pin tract infection, 8% patients had nonunion, and 4% patients had K-wire migration. When the results were analyzed using the Flynn criteria, they were excellent (48% group A patients versus 36% patients of group B), 32% patients in group A had good results and 28% in group B, 20% patients of group B versus 12% patients of group A were regarded as fair, and 8% patients of group A versus 16% patients of group B were considered as poor. The patients who carried angle loss were 12% of group A versus 24% of group B, and who complained about loss of motion were 15% patients of group A versus 25% patients of group B were classified according to Flynn criteria Conclusion: Percutaneous cross pinning is concluded as the better, and more predictable treatment method in terms of management, as compared to two lateral pinning method to treat the Supra-condylar fractures. Key Words: Percutaneous cross pinning, two lateral pinning, supra-condylar fracture, humerus

A Mini-Open Approach to Medial Pinning in Pediatric Supracondylar Humeral Fractures May Be Safer Than Previously Thought.

Displaced pediatric supracondylar humeral fractures (SCHFs) are stabilized after reduction by smooth pins. Although some SCHFs are biomechanically stable after lateral-only entry pinning (lateral pinning), an additional medial entry pin (cross-pinning) confers superior stabilization in some SCHFs. There is a recognized risk of iatrogenic ulnar nerve injury with medial entry pinning. The best existing evidence has estimated an iatrogenic ulnar nerve injury rate of approximately 3.4% in cross-pinning. In similar studies, the rate of iatrogenic nerve injury (all nerves) in lateral pinning is estimated at 1.9%. This study aimed to use a large, single-center, single-technique (mini-open) retrospective case series to determine the rate of iatrogenic ulnar nerve injury in cross-pinning. Patients undergoing percutaneous cross-pinning via the mini-open technique for SCHFs from 2007 to 2017 were retrospectively reviewed. Injury characteristics, operative variables, fixation technique, and complications, such as iatrogenic nerve injury, were recorded. Patients who underwent operative treatment at another hospital, had no postoperative follow-up, or died due to polytrauma were excluded. In this study, 698 patients undergoing cross-pinning during the study period were identified. Patients treated with cross-pinning had severe fractures, including a total of 198 preoperative neurovascular injuries (28.4%), 32 patients (4.6%) with skin tenting, and 19 patients (2.7%) with open fractures. Iatrogenic nerve injury was reported in 3 cases (0.43%), all of which affected the ulnar nerve. In 2 of 3 cases of iatrogenic nerve injury, the ulnar nerve symptoms resolved at a mean follow-up of 15 weeks. The mini-open approach for medial pin insertion is safer than previous estimates. Here, in the largest single-center study of cross-pinning for SCHFs, the iatrogenic ulnar nerve injury rate of 0.43% was nearly 10 times lower than estimated rates from recent meta-analyses. Considering all nerves, the iatrogenic injury rate for this cross-pinning cohort was also lower than the estimated iatrogenic nerve injury rate for lateral pinning. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Compare the Functional Outcomes of Closed Reduction and Percutaneous Cross Pinning versus Lateral Pinning in Supracondylar Fracture of Humerus in Children

Objective: To determine results of treating supracondylar fracture of the humerus in children using percutaneous cross pinning versus two lateral pinning. Study Design: Prospective study Place and Duration of Study: Department of Orthopaedics, King Abdullah Teaching Hospital Mansehra from 1st November 2020 to 30th April 2021 Methodology: Eighty four patients of both genders were enrolled. Baseline demographic details of patient’s age, sex and body mass index were recorded after taking consent. Patients aged between 2-14years were included. Children with supracondylar humerus fractures were enrolled and divided equally into 2-groups. Group I had 42 patients and received percutaneous cross pinning technique and group II had 42 patients underwent lateral pinning. Radiological and functional results were assessed by Flynn’s criteria among both groups and frequency of complications was also observed. Results: There were 50 (59.5%) males (25 in each group) and 34 (40.5%) were females (17 in each group. Mean age of the patients in group I was 5.14±9.88 years and in group II mean age was 6.14±8.35 years. Sports 60 (71.43%) was the most common cause of fracture followed by traffic accidents 17 (20.24%) and the rest were 7 (8.3%) fall from the height. Mean surgical time in group I was 30.42±6.09 minutes while in group II mean time was 34.24±2.16 minutes. Mean radiation time in group I was 3.98±9.44 sec and in group II radiation time was 2.11±1.1sec. According Flynn’s criteria excellent results in group I were found in 25 (59.5%) cases, good results in 12 (28.6%) and fair results found in 5 (11.9%) while in group II excellent results were found in23 (54.8%), good results in 15 (35.7%) and fair results in 4 (9.5%). Significantly no difference in outcomes was observed among both groups. Conclusion: Both methods of treatment of supracondylar fractures of humerus are safe and successful however less operative and high time of radiation in cross percutaneous pinning compared to two lateral pinning has been found. Keywords: Percutaneous cross pinning, Two lateral pinning, Supracondylar humerus fracture

Supracondylar Fracture of Humerus in Children Treated with Closed Reduction and Percutaneous Cross Pinning VS Lateral Pinning

Objective: The aim of this study is to determine the outcomes between percutaneous cross pinning vs two lateral pinning in treatment of closed reduction supracondylar fracture of humerus in children. Study Design: Prospective study Place and Duration: Study was conducted in Orthopaedic Unit Ayub Medical Teaching Institute Abbottabad and DHQ Teaching Hospital Gomal Medical College Dera Ismail Khan during from October 2019 to May 2020 (09 months duration). Methods: Total 60 patients of both genders were presented in this study. Baseline demographically details of patients age, sex and body mass index were recorded after taking consent. Patients were aged between 2-14 years were included. Children who had supracondylar humerus fractures were enrolled and divided equally into 2-groups. Group I had 30 patients and received percutaneous cross pinning technique and group II had 35 patients underwent for lateral pinning. Radiological and functional results were assessed by Flynn’s criteria among both groups, frequency of complications was also observed. Complete date was analyzed by SPSS 22.0 version. Results: Total 36 (60%) were males (18 in each group) and 24 (40%) were females (12 in each group. Mean age of the patients in group I was 6.14±3.12 years and in group II mean age was 5.66±5.28 years. Sports 45 (75%) was the most common cause of fracture followed by traffic accidents 10 (16.67%) and the rest were 5 (8.33%) fall from the height. Mean surgical time in group I was 31.24±2.16 minutes while in group II mean time was 33.42±1.61 minutes. Mean radiation time in group I was 2.01±1.1 sec and in group II radiation time was 1.34±1.1 sec. According flynn’s criteria excellent results were found in 20 (66.7%) cases, good results in 8 (26.7%) and fair results found in 2 (6.7%) while in group II excellent results were found in 19 (63.33%), good results in 9 (30%) and fair results in 2 (6.7%). Significantly no any difference in outcomes was observed among both groups. Conclusion: We concluded in this study that the both techniques are safe and effective for the treatment of closed reduction supracondylar fracture of humerus in children but less operative and high radiation time was observed in percutaneous cross pinning as compared to two lateral pinning. Keywords: Percutaneous cross pinning, Two lateral pinning, Supracondylar humerus fracture, Children

A systematic review and meta-analysis of two different managements for supracondylar humeral fractures in children

BackgroundThe objective of this meta-analysis was to illustrate the clinical outcomes and safety of two different managements for supracondylar humeral fractures in children.MethodsIn January 2018, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for two different managements for supracondylar humeral fractures in children were retrieved. The primary endpoint was the cosmetic and clinical outcomes based on the criteria of Flynn, ulnar nerve injury, and the occurrence of infection. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.ResultsSix clinical studies with 581 patients were ultimately included in the meta-analysis. There was no significant difference between the closed reduction and percutaneous cross-pinning, and open reduction and internal fixation in terms of the cosmetic and clinical outcomes based on the criteria of Flynn, ulnar nerve injury, and the occurrence of infection (P > 0.05).ConclusionsClosed reduction and percutaneous pinning, and open reduction and internal fixation of supracondylar humeral fractures in children result in similar construct stability and functional outcome. More high quality randomized controlled trials are needed to identify this conclusion.

Mechanical advantages of a truss-structure-based fracture fixation system--a novel fracture fixation device "PinFix".

A small, light, ball-joint device called PinFix, which can instantly convert a simple percutaneous cross pin fracture fixation system into a rigid external fracture fixation system based on truss structure, was developed. The purpose of this study was to compare the mechanical load and breaking strength of this truss-structure-based fixation system to that of the conventionally used external cantilever structure-based fixation system. Three types of mechanical loading tests, axial, bending, and torsion, were performed on an artificial fractured bone treated with either three-dimensional PinFix fixation, two-dimensional PinFix fixation, or conventional external fixation. The three- and two-dimensional PinFix fixations showed significantly more stiffness than conventional fixation on all three loading tests. Finite element analysis was next performed to calculate the stress distribution of the parts in PinFix and in the conventional fixator. The applied stress to the rod and connectors of PinFix was much less than that of the conventional external fixator. These results reflected the physical characteristic of truss structure in which applied load is converted to pure tension or compression forces along the members of the PinFix. In conclusion, PinFix is a simple fracture fixation system that has a truss-structure with a high rigidity.

Fractures of the Distal Radius Treated With Cross-Pin Fixation and a Nonbridging External Fixator, the CPX System: A Preliminary Report

To present the preliminary findings of distal radius fractures (DRF) treated with percutaneous cross-pin fixation and a nonbridging external fixator, the Cross-Pin Fixation (CPX) system. Thirty-five consecutive patients with 37 DRFs were selected from a series of 51 DRFs for closed reduction, percutaneous pinning, and external fixation with the CPX system. Outcome was determined by studying (1) radiological measurements of radial height, palmar tilt, radial inclination and ulnar variance (UV); (2) grip and pinch strength; (3) wrist active range of motion; and (4) patient outcome instruments-the Patient-Rated Wrist Hand Evaluation and the Disabilities of the Arm, Shoulder, and Hand. We are reporting on 21 patients, 13 females and 8 males, mean age 54 years (range, 27 to 87 y) with AO type fractures A2, B2, B3, C1, C2, and C3. Follow-up was a minimum of 1 year (range, 12 to 36 months). Wrist rehabilitation began at a mean of 10 days (range, 4 to 16 d) after surgery. There was no loss of reduction. Final mean grip and lateral pinch strength recovered 86% and 94%, respectively, and active range of motion increased to a minimum of 89% of the noninjured side. Disabilities of the Arm, Shoulder, and Hand showed change in functional status (minimal detectable change at 95% confidence level) at 4 and 12 weeks. The Patient-Rated Wrist Hand Evaluation results reported resumption of usual activities in the early postoperative period. One patient developed type I complex regional pain syndrome, which resolved, and one patient had residual transient mild superficial radial nerve sensitivity. There were no pin track infections, nonunions, or tendon injuries. All patients returned to their prior employment and activities. The CPX system is a minimally invasive technique of closed reduction and internal fixation for displaced, reducible extra-articular and nondisplaced and displaced reducible intra-articular fractures of the distal radius, allowing rehabilitation of the wrist and resumption of usual activities while maintaining fracture reduction. Therapeutic IV.

Dynamics of the ulnar nerve after percutaneous pinning of supracondylar humeral fractures in children

This prospective study was performed to evaluate and compare the morphological changes and dynamics of the ulnar nerve after percutaneous cross-pinning with Kirshner wire (group 1; 13, mean age 8.3 years, 10 male and three female children) and only lateral pinning (group 2; eight, mean age 7.6 years, six male and two female children) of displaced unilateral supracondylar fractures in children's elbows using ultrasonography in comparison with the contralateral healthy elbows. Postoperative evaluation revealed that ulnar nerve movement was reduced and the major axis diameter of elbow flexion and ulnar nerve was larger (P<0.05) than the major axis diameter in the elbow extension in group 1 than group 2. We think that the treatment of the displaced supracondylar fracture of the humerus in children with only a lateral Kirshner wire would be safer and more convenient.

Operative management of type III extension supracondylar fractures in children

The purpose of this study was to compare primarily open versus primarily closed surgical treatment of Gartland type III extension supracondylar fractures in children. Also the outcomes of different pinning techniques in open surgery were evaluated retrospectively. Eighty displaced type III extension supracondylar fractures treated consecutively at two different centres were included. The treatment protocol of one institute was primarily closed reduction and percutaneous cross-pinning (n = 43). The treatment protocol of the other institute was primarily open reduction and internal fixation (n = 37) with two lateral parallel pins (n = 11), cross pins (n = 11) and two lateral and one medial pin (n = 15) according to the stability and configuration of the fracture. According to Flynn's criteria the outcomes of the open and closed reduction groups were not statistically significant (P > 0.05). Although the outcomes of closed reduction showed no superiority over open reduction, it should be the first choice of treatment due to its low morbidity and short hospital stay.

Correlation between posteromedial or posterolateral displacement and cubitus varus deformity in supracondylar humerus fractures in children

Cubitus varus deformity is one of the most common complications after displaced supracondylar humeral fractures in children. The purpose of this study was to evaluate the relationship between the fracture displacement and cubitus varus deformity in displaced supracondylar humerus fractures. Seventeen patients (11 males/6 females; mean age 7 years) with cubitus varus deformities occurring after Gartland type III posteromedial or posterolateral displaced supracondylar humerus fractures were evaluated with clinical and serial radiographic examinations. All patients had been treated surgically by open reduction through a medial approach and percutaneous cross-pinning. All fractures were reduced anatomically. Ten of the patients were operated within the first 24 h. The time interval between the initial injury and the surgical procedure for the remaining seven patients was 5.3 days on average (range 2-10 days). The carrying angle and range of motion of the elbow were measured throughout the follow-up period. The mean follow-up time was 3.7 years (range 2-12 years). Five patients with type III-B fractures had a mean carrying angle loss of 8.8 degrees (range 6-10 degrees ), whereas for the remaining 12 type III-A patients the mean loss was 15 degrees (range 6-29 degrees ) (P = 0.019). None of the patients in this study demonstrated limited elbow motion. According to the Flynn criteria, the results were good in five type III-B patients. There was no statistically significant relationship between the loss of carrying angle and the delay before the surgical procedure (P = 0.615 in type III-A, P = 0.096 in type III-B). The carrying angle loss was more significant in type III-A fractures compared with type III-B in this series. These results suggest that although anatomic reduction has been achieved by surgical treatment without loss of reduction, there is still a risk for cubitus varus deformity for type III-A fractures due to the initial compression of the medial column or, in other words, physeal injury.

Delayed surgical treatment of supracondylar humerus fractures in children using a medial approach

The appropriate management of supracondylar humerus fractures in children is frequently delayed due to various factors, and there is still no agreement on the treatment of choice. The purpose of this study was to evaluate the effects of delayed treatment of displaced supracondylar humerus fractures on the treatment results and complication rate. A total of 31 children with supracondylar humerus fractures who had not received adequate treatment for their displaced fractures were included in this study. The conditions leading to delayed treatment mainly included severe swelling or skin problems around the elbow and the health facility problems unique to our district. The mean delaying time was 6 days (range 2-19 days). There were 24 males and 7 females with a mean age of 7 years (range 1-13 years). The fractures were classified as type III-A (n = 15; 48%) and type III-B (n = 16; 52%) according to Gartland. Surgical treatment consisting of sentiment manual reduction through a medial approach and percutaneous cross-pinning was applied to all. No image intensifier was used during the procedures. A long-arm splint was used for post-operative immobilization. The average hospital stay was 2 days (range 1-3 day) and the patients were followed clinically and radiographically for an average of 4 years (range 2-11 years). Pins were removed at the end of the third week post-operatively, at which time the range of motion exercises were begun. None of the patients required physical therapy and full functional recovery was achieved within 3 months in 29 (93.5%) patients and within 5 months in the remaining 2 (6.5%). Two (6.5%) pre-operative nerve injuries (1 interosseous, 1 ulnar) were resolved spontaneously within 3 months post-operatively. At the final follow-up, 7 (22.5%) patients had cubitus varus deformity. Except for 2 (6.5%) pin-tract infections, which were resolved by oral antibiotics and pin removal, none of the patients had early or late complications, not even neurological deficit or myositis ossificans. Delayed presentation of displaced supracondylar humerus fractures in children did not increase complication rates or unsatisfactory results following an open reduction. Medial approach and cross-pinning is an effective and reliable treatment method for these fractures.

Morphology and dynamics of the ulnar nerve in the cubital tunnel after percutaneous cross-pinning of supracondylar fractures in childrenʼs elbows: an ultrasonographic study

After the 12.6-month (3-30) follow-up period, the morphology and dynamics of the ulnar nerve in the cubital tunnel were examined with ultrasonography on operated (group 1) and opposite (group 2) elbows of 13 children who had percutaneous cross-pin fixation for displaced supracondylar humerus fractures. When we compared group 1 and group 2, nerve morphology was similar (P>0.05), but nerve dynamics were found to be decreased or absent for seven (54%) elbows in group 1 (P<0.05). The medial K-wire may damage the ulnar nerve dynamics in the cubital tunnel.

Iatrogenic ulnar nerve injury after percutaneous cross-pinning of supracondylar fracture in a child

Supracondylar fracture of the humerus is the most common fracture of the elbow in children and has been treated by a variety of methods. Recently, stabilization of reduced fractures with percutaneous pin fixation has become the accepted method of treatment. Ulnar nerve injury is a complication of percutaneous pinning of supracondylar fractures, although many authors have reported that it resolves spontaneously after removal of the pin.

Iatrogenic ulnar nerve injury after percutaneous cross-pinning of supracondylar fracture in a child

Supracondylar fracture of the humerus is the most common fracture of the elbow in children and has been treated by a variety of methods.2,9,14 Recently, stabilization of reduced fractures with percutaneous pin fixation has become the accepted method of treatment.4,9,14 Ulnar nerve injury is a complication of percutaneous pinning of supracondylar fractures, although many authors have reported that it resolves spontaneously after removal of the pin.2,5,12,14

Ulnar Nerve Palsies After Percutaneous Cross-Pinning of Supracondylar Fractures in Children's Elbows

From 1991 to 1994, 375 supracondylar fractures had percutaneous pinning after closed or open reduction. Nineteen of these with normal preoprative neurologic examinations had postoperative ulnar nerve palsies. All but two of the 19 were followed up. These 17 patients had complete return of function. Only four of the 17 had the medial pins removed, and two others had explorations, which showed no interruption of the nerve. Many of these patients did not have complete return of function until after 4 months. From this and other studies, it is clear that ulnar nerve palsies occurring after percutaneous pinning of the supracondylar fracture usually resolve spontaneously.

Treatment of the Displaced Supracondylar Fracture of the Humerus (Type III) with Closed Reduction and Percutaneous Cross-Pin Fixation

Forty-five consecutive patients treated for displaced supracondylar fractures of the humerus, Type III, by means of closed reduction and percutaneous crossed-pin fixation, were studied retrospectively. Thirty-three were available at an average of 33 months post-injury for clinical and radiographic follow-up of the affected and nonaffected extremities. Five additional patients returned radiographs for analysis. Baumann's angle and a lateral humeral capitellar angle were assessed and found to be useful clinical guides for assessing the adequacy of maintenance of fracture reduction. Based upon Flynn's criteria, 31 of 33 patients clinically assessed had a satisfactory result. Closed reduction with percutaneous pin fixation is believed to represent a safe, reliable, and efficient method of managing this difficult fracture.