A prospective randomised non-blinded comparison of conventional and Dorgan's crossed pins for paediatric supracondylar humeral fractures.
BACKGROUND
Closed reduction and percutaneous pinning are the preferred treatment of displaced supracondylar humeral fractures in children. The purpose of this study is to evaluate the non-standard Dorgan's method and compare its results with those of the standard percutaneous cross pinning method in treatment of unstable or irreducible Gartland type II and III supracondylar humeral fractures in children.


METHODS
This was a prospective evaluation of 138 consecutive patients with Gartland type II or III extension supracondylar humeral fractures referred to University Children's Hospital during a four-year period. The patients were randomized into two groups: the first group, comprised of 71 patients, was treated with standard pin configuration and the second group, comprised of 67 patients, underwent Dorgan's method. The study included 88 boys and 50 girls aged 1.5-11.4 years (mean 6.5±2). At initial presentation 8.7% (n-12) fractures were classified as Gartland type IIa, 25.4% (n-35) as Gartland type IIb and 65.9% (n-91) as Gartland type III.


RESULTS
Flynn's criteria were used to evaluate the results. An excellent clinical outcome was reported in about 90% of patients (n-90) treated with standard pin configuration and 89.5% (n-60) of patients treated with Dorgan's method. There were no statistically significant differences in outcomes between the groups in terms of their gender, age, fracture types, function and cosmetics. Neurological lesions were observed in 9.9% of patients (n=7) who were treated using the standard configuration Kirschner pins, while in those treated by Dorgan's method neurological complications were not observed. However, the procedure time was longer (mean 36.54±5.65min) and radiation exposure significantly higher (mean 10.19±2.70 exposures) in the group that was treated using Dorgan's method, compared to the conventional method (mean 28.66±3.76min and 7.54±1.63 exposures).


CONCLUSIONS
Two laterally inserted crossed pins provide adequate stability with good functional and cosmetic outcome for most unstable paediatric supracondylar humeral fractures with no risk of iatrogenic ulnar nerve injury.
Medical Faculty University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia.
Sinisa
S
Dučić
University Children's Hospital, Belgrade, Serbia.
Vladimir
V
Radlović
University Children's Hospital, Belgrade, Serbia.
Bojan
B
Bukva
Medical Faculty University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia.
Zoran
Z
Radojičić
Department of Orthopaedic Surgery, University Hospital Sveti Duh, Zagreb, Croatia.
Goran
G
Vrgoč
Department of ENT, Head and Neck Surgery, University Hospital Sveti Duh, Zagreb, Croatia.
Iva
I
Brkić
Special Hospital for CV Diseases, Belgrade, Serbia.
Tatjana
T
Jaramaz Dučić
Clinic for Orthopaedic Surgery "Lovran", School of Medicine, University of Rijeka, Rijeka, Croatia.
Hari
H
Jurdana
University Children's Hospital, Belgrade, Serbia.
Dusan
D
Abramović
Hospital for Pediatric surgery and orthopedics, Nis, Serbia.
Nikola
N
Bojović
Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 15, 10000 Zagreb, Croatia, Croatia. Electronic address: lovro.stefan1510@gmail.com.
Lovro
L
Štefan
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001858:Bone Nails; D001864:Bone Wires; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006776:Hospitals, Pediatric; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D007223:Infant; D008297:Male; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000517:prevention & control*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Children; Outcome; Percutaneous pinning; Supracondylar humerus fracture