title: Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?
abstract: OBJECTIVE
  Closed reduction with percutaneous pinning is the treatment of choice for displaced supracondylar humerus fractures in children. In addition to configuration of pin fixation, many factors have been attributed to loss of reduction (LOR). The aim of the present study was to review potential factors that contribute to loss of reduction in the closed management of type III pediatric supracondylar fractures.
  
  
  METHODS
  Treatment of 87 patients with type III supracondylar fractures was reviewed to determine factors associated with loss of reduction; 48 patients were treated with lateral pinning and 39 with crossed-pinning after closed reduction. Outcome parameters included radiographic maintenance of postoperative reduction.
  
  
  RESULTS
  Lateral or crossed-pin configuration, pin spread at fracture site, pin-spread ratio (PSR), and direction of coronal displacement of the fracture were not associated with LOR. A significant difference (p = 0.01) was found between LOR rates of patients with medial wall communication and LOR.
  
  
  CONCLUSIONS
  Medial wall communication is a contributing factor to LOR in the management of type III supracondylar fractures. Cross-pinning should be preferred when medial wall communication is present, to provide more stable fixation.
  
  
  METHODS
  Level IV, Therapeutic study.
authors.affiliation: Izmir Tepecik Training and Research Hospital, Department of Orthopedics and Traumatology, Izmir, Turkey. Electronic address: areiss@superonline.com.
authors.forename: Ali
authors.initials: A
authors.lastname: Reisoglu
authors.affiliation: Katip Celebi University Hospital, Department of Orthopaedics, Izmir, Turkey.
authors.forename: Cemal
authors.initials: C
authors.lastname: Kazimoglu
authors.affiliation: Izmir Tepecik Training and Research Hospital, Department of Orthopedics and Traumatology, Izmir, Turkey.
authors.forename: Emre
authors.initials: E
authors.lastname: Hanay
authors.affiliation: Izmir Tepecik Training and Research Hospital, Department of Orthopedics and Traumatology, Izmir, Turkey.
authors.forename: Haluk
authors.initials: H
authors.lastname: Agus
mesh_terms: D001858:Bone Nails; D002648:Child; D002675:Child, Preschool; D000070628:Closed Fracture Reduction / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D017759:Fractures, Malunited / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D006811:Humerus / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011859:Radiography / Q000379:methods; D014421:Turkey
keywords: Fracture; Loss of reduction; Pin configuration; Supracondylar humerus