Radiographic study of lateral and reverse lateral crossed pinning for supracondylar humeral fractures in children

Abstract

Introduction: Supracondylar fracture of the humerus is the most common type of elbow fracture in children. Lateral pinning or cross-pinning is a commonly used treatment approach for these fractures. The superiority of crossed pinning over lateral pinning remains controversial owing to possible ulnar nerve damage.The lateral double-pinning technique introduced by Dorgan achieves good stabilization and reduces the rate of ulnar nerve damage. A reverse lateral pin is inserted from the proximal lateral part of the fracture site and directed toward the medial condyle. In addition to conventional lateral pinning, reverse lateral pinning can be performed in a crossed pinning configuration without causing ulnar nerve damage. We performed lateral and reverse lateral crossed pinning (LRP) for supracondylar humeral fractures in children and compared the radiological outcomes with those of conventional crossed pinning (CCP). Patients and methods: Thirty patients underwent CCP (23 boys and 7 girls, mean age: 7.2 years, Gartland type II:13, III:17), and 20 patients underwent LRP (13 boys and 7 girls, mean age: 5.6 years, Gartland type II:11, III:9). The Baumann angle (BA), tilting angle (TA), and distance between the anterior edge of the capitellum and anterior humeral line (ACD) were compared between the groups. Results: The correction losses of the mean BA, TA, and ACD in the CCP group were 0.4° ± 4.7°, 3.2° ± 7.3°, and 0.4 ± 2.4 mm, respectively, and those in the LRP group were 0.9° ± 2.3°, 0.0° ± 4.7°, and 0.1 ± 2.2 mm, respectively. No significant differences were observed in the radiological parameters of postoperative or correction losses between the groups. Conclusions: The radiographic investigations confirmed that LRP shows adequate stability, similar to CCP. Although preventive measures against radial nerve injury should be implemented, LRP may be a useful alternative treatment for pediatric supracondylar fractures.

Keywords

• Supracondylar humeral fracture
• Children
• Pinning
• Crossed pinning
• Reverse lateral crossed pinning
• Anterior humeral line