Cross pinning of supracondylar fractures from a lateral approach. Stabilization achieved with safety.
OBJECTIVE
Various pin configurations are possible to stabilize a supracondylar fracture. While cross pinning gives the best stabilty the disadvantage is the risk of iatrogenic ulnar nerve injury. We combine a cross pin fixation with a lateral approach. The aim of the study was to prove our method retrospectively to show the advantage of lateral cross-pinning achieving stabilty and avoiding ulnar nerve injury.


METHODS
Between 1 January 2001 and 31 December 2002, 84 supracondylar fractures were treated with invasive surgical procedure. The intention was a primary closed reduction. Following closed reduction under general anaesthesia, two K-wires were introduced from the lateral side, one ascending and the other descending. If it was not possible to perform a closed reduction, an open reduction was performed by medial-lateral crossed K-wire fixation. After either an open or closed reduction, the pins were buried under the skin. The results were evaluated using Flynn's score. The mean time of follow-up was 18.9 months.


RESULTS
Seventy-seven percent of the patients were treated with a closed reduction, while 23% needed an open reduction. A clinical follow-up examination was done at an average of 18.9 months following the trauma. Of those treated with a closed reduction alone, 93% had an excellent or good functional result. Of those requiring an open reduction, 88% had excellent or good result. None of our patients exhibited secondary dislocation or iatrogenic ulnar palsies.


CONCLUSIONS
Closed reduction and lateral crossed pin fixation with ascending and descending K-wires buried under the skin is an effective method to treat type II and III supracondylar fractures in children. The method gives stability and avoids iatrogenic ulnar nerve injuries.
Eberhardt
Oliver
O
Orthopaedic Department, Olgahospital Stuttgart, Bismarckstr. 8, 70176, Stuttgart, Germany, DieEberhardts@aol.com.
Fernandez
Francisco
F
Ilchmann
Thomas
T
Parsch
Klaus
K