A comparative study of two percutaneous pinning techniques (lateral vs medial-lateral) for Gartland type III pediatric supracondylar fracture of the humerus.
BACKGROUND
The management of displaced supracondylar fracture of the humerus with closed reduction and percutaneous pin fixation is the most widely accepted method of treatment, but controversy continues regarding the pin fixation techniques. A prospective randomized controlled study was undertaken to compare the stability, functional outcome and iatrogenic ulnar nerve injury between lateral pin fixation and medial-lateral pin fixation.


METHODS
Sixty-two patients with Gartland type III supracondylar fracture of the humerus were randomized into two groups-lateral pin fixation (n = 31) and medial-lateral pin fixation (n = 31). Primary assessment was performed for major loss of reduction and iatrogenic ulnar nerve injury. Secondary assessment included clinical outcome, elbow range of motion, radiographic measurements, Flynn grade, and complications.


RESULTS
There were two (6.5 %) iatrogenic ulnar nerve injury cases in the medial-lateral entry group and two (6.5 %) cases with mild loss of reduction in the lateral entry group. No major loss of reduction was observed in either of the groups. There was no statistically significant difference in change of Baumann angle, metaphyseal-diaphyseal angle, Flynn grade, carrying angle, and the total elbow range of motion (P < 0.05) between the two groups.


CONCLUSIONS
Lateral pin fixation offers similar functional and radiological outcome and almost equal mechanical stability compared with medial-lateral pinning without the risk of iatrogenic ulnar nerve injury. LEVEL OF EVIDENCE [OCEBM 2011]: Level 2.
Trauma Centre, Banaras Hindu University, Varanasi, UP, 221005, India. dr.kumarprashant83@gmail.com.
Kumar
K
Prashant
Institute of Medical Sciences and Research Center, Jagatpura, Jaipur, India.
Devendra
D
Lakhotia
Department of Orthopaedics, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Tulsi Das
TD
Bhattacharyya
Department of Orthopaedics, Gauhati Medical College and Hospital, Guwahati, Assam, India.
Anil Kumar
AK
Mahanta
Mysore Medical College and Research Institute, Mysore, India.
Aakhil
A
Ravoof
D001858:Bone Nails; D002648:Child; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D007049:Iatrogenic Disease; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000293:injuries
Humerus; Iatrogenic ulnar nerve injury; Percutaneous fixation; Randomized controlled study; Supracondylar fracture