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ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2003, Number 6

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Acta Ortop Mex 2003; 17 (6)

Comparative analysis of crossed-pinning vs lateral-pinning in the supracondylar fractures of the humerus in children

Díaz-Borjón E, Martínez DSA, Valle-de Lascurain G, Guzmán-Robles O

Language: Spanish
References: 74
Page: 298-305
PDF size: 84.92 Kb.


ABSTRACT

Introduction: Displaced supracondylar fractures of the humerus in children are frequently treated surgically with percutaneous pin fixation using Kirschner wires. Controversy has aroused from the two most frequent modalities, crossed-pinning vs lateral pinning because of nerve injury in the former and instability in the later. Methods: In this prospective, randomized trial, 50 patients with displaced supracondylar fractures of the humerus between the age of 4 and 14, treated surgically with crossed (N = 27) or lateral (N = 23) pinning were followed for 6 months. Results: ninety-six percent of all patients had excellent aesthetic results according to Flynn’s criteria, with no statistical difference between both groups (p = 0.40); 92% of all patients had good or excellent functional results according to Flynn’s functional criteria, no statistical difference was observed (p = 0.45). Elbow range of motion in flexion and extension were similar. Six cases of ulnar nerve palsy were identified in the crossed-pinning group of patients; diagnosis was confirmed with electromyography and all resolved spontaneously by the end of our study. Discussion: Both, lateral and crossed-pinning of percutaneous Kirschner wires offer adequate fixation and fracture stability as demonstrated by similar aesthetic and functional results. However, the high incidence of ulnar nerve palsy in the crossed-pinning group could be a disadvantage in the presence of significant edema, making bony marks harder to palpate.


REFERENCES

  1. Arazi M, Ogun TC, Kapicioglu MI: The Monteggia lesion and ipsilateral supracondylar humerus and distal radius fractures. J Orthop Trauma 1999; 13(1): 60-3.

  2. Arino VL, Lluch EE, Ramirez AM, Ferrer J, Rodriguez L, Baixauli F: Percutaneous fixation of supracondylar fractures of the humerus in children. J Bone Joint Surg [Am] 1977; 59(7): 914-6.

  3. Aronson DD, Prager BI: Supracondylar fractures of the humerus in children. A modified technique for closed pinning. Clin Orthop 1987; (219): 174-84.

  4. Badhe NP, Howard PW: Olecranon screw traction for displaced supracondylar fractures of the humerus in children. Injury 1998; 29(6): 457-60.

  5. Bailey GG: Nerve injuries in supracondylar fractures of the humerus in children. N Engl J Med 1939; 221: 260.

  6. Banskota A, Volz RG: Traumatic laceration of the radial nerve following supracondylar fracture of the elbow. A case report. Clin Orthop 1984; (184): 150-2.

  7. Blanco JS: Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop 1998; 18(6): 824.

  8. Bosanquet JS, Middleton RW: The reduction of supracondylar fractures of the humerus in children treated by traction-in-extension. A review of 18 cases. Injury 1983; 14(4): 373-80.

  9. Brown IC, Zinar DM: Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop 1995; 15(4): 440-3.

  10. Buhl O, Hellberg S: Displaced supracondylar fractures of the humerus in children. Acta Orthop Scand 1982; 53(1): 67-71.

  11. Campbell CC, Waters PM, Emans JB, Kasser JR, Millis MB: Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop 1995; 15(1): 47-52.

  12. Canale ST: Fractures and dislocations in children. In Crenshaw AH, editor: Campbell’s Operative Orthopedics, St. Louis, 1992 Mosby-Year Book.

  13. Cheng JC, Lam TP, Shen WY: Closed reduction and percutaneous pinning for type III displaced supracondylar fractures of the humerus in children. J Orthop Trauma 1995; 9(6): 511-5.

  14. Cheng JC, Shen WY: Limb fracture pattern in different pediatric age groups: a study of 3,350 children. J Orthop Trauma 1993; 7(1): 15-22.

  15. Cramer KE, Green NE, Devito DP: Incidence of anterior interosseous nerve palsy in supracondylar humerus fractures in children. J Pediatr Orthop 1993; 13(4): 502-5.

  16. De Boeck H, De Smet P: Valgus deformity following supracondylar elbow fractures in children. Acta Orthop Belg 1997; 63(4): 240-4.

  17. De Boeck H, De Smet P, Penders W, De Rydt D: Supracondylar elbow fractures with impaction of the medial condyle in children. J Pediatr Orthop 1995; 15(4): 444-8.

  18. Dodge HS: Displaced supracondylar fractures of the humerus in children-treatment by Dunlop’s traction. J Bone Joint Surg 1972; 54-(7): 1408.

  19. Dormans JP, Squillante R, Sharf H: Acute neurovascular complications with supracondylar humerus fractures in children. J Hand Surg [Am] 1995; 20(1): 1-4.

  20. Dunlop J: Transcondylar fractures of the humerus in childhood. J Bone Joint Surg 21-A: 59.

  21. Elstrom JA, Pankovich AM, Kassab MT: Irreducible supracondylar fracture of the humerus in children. A report of two cases. J Bone Joint Surg [Am] 1975; 57(5): 680-1.

  22. Farnsworth CL, Silva PD, Mubarak SJ: Etiology of supracondylar humerus fractures. J Pediatr Orthop 1998; 18(1): 38-42.

  23. Flynn JC, Matthews JG, Benoit RL: Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years’ experience with long-term follow-up. J Bone Joint Surg [Am] 1974; 56(2): 263-72.

  24. Fowles JV, Kassab MT: Displaced supracondylar fractures of the elbow in children. A report on the fixation of extension and flexion fractures by two lateral percutaneous pins. J Bone Joint Surg [Br] 1974; 56B(3): 490-500.

  25. Gartland JJ: Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 1959; 102: 145-154.

  26. Gjerloff C, Sojbjerg JO: Percutaneous pinning of supracondylar fractures of the humerus. Acta Orthop Scand 1978; 49(6): 597-9.

  27. Grant HW, Wilson LE, Bisset WH: A long-term follow-up study of children with supracondylar fractures of the humerus. Eur J Pediatr Surg 1993; 3(5): 284-6.

  28. Haddad RJ Jr, Saer JK, Riordan DC: Percutaneous pinning of displaced supracondylar fractures of the elbow in children. Clin Orthop 1970; 71: 112-7.

  29. Hammond WA, Kay RM, Skaggs DL: Supracondylar humerus fractures in children. AORN J 1998; 68(2): 186-99.

  30. Hanlon CR, Estes WL Jr: Fractures in childhood, a statistical analysis. Am J Surg 1954; 87(3): 312-323.

  31. Holmberg I: Fractures of the distal end of the humerus in children. Acta Chir Scand (suppl.) 1945, 103.

  32. Hoyer A: Treatment of supracondylar fracture of the humerus by skeletal traction in an abduction splint. J Bone Joint Surg 1952; 34-A: 623.

  33. Ippolito E, Caterini R, Scola E: Supracondylar fractures of the humerus in children. Analysis at maturity of fifty-three patients treated conservatively. J Bone Joint Surg [Am] 1986; 68(3): 333-44.

  34. Kekomaki M, Luoma R, Rikalainen H, Vilkki P: Operative reduction and fixation of a difficult supracondylar extension fracture of the humerus. J Pediatr Orthop 1984; 4(1): 13-5.

  35. Kramhoft M, Keller IL, Solgaard S: Displaced supracondylar fractures of the humerus in children. Clin Orthop 1987; (221): 215-20.

  36. Labelle H, Bunnell WP, Duhaime M, Poitras B: Cubitus varus deformity following supracondylar fractures of the humerus in children. J Pediatr Orthop 1982; 2(5): 539-46.

  37. Lal GM, Bhan S: Delayed open reduction for supracondylar fractures of the humerus. Int Orthop 1991; 15(3): 189-91.

  38. Landin LA: Fracture patterns in children: Analysis of 8,682 fractures with special reference to incidence, etiology and secular changes in a Swedish urban population 1950-1979. Acta Orthop Scand Suppl 1983; 202: 1-109.

  39. Landin LA, Danielsson LG: Elbow fractures in children. An epidemiological analysis of 589 cases. Acta Orthop Scand 1986; 57(4): 309-12.

  40. Lins RE, Simovitch RW, Waters PM: Pediatric elbow trauma. Orthop Clin North Am 1999; 30(1): 119-32.

  41. Lipscomb PR, Burleson RJ: Vascular and neural complications in supracondylar fractures of the humerus in children. J Bone Joint Surg 1955; 37-A(3): 487-492.

  42. Lyons JP, Ashley E, Hoffer MM: Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children’s elbows. J Pediatr Orthop 1998; 18(1): 43-5.

  43. Maylahn DJ, Fahey JJ: Fractures of the elbow in children. Review of three hundred consecutive cases. J Am Med Assoc 1958; 166(3): 200-208.

  44. McGraw JJ, Akbarnia BA, Hanel DP, Keppler L, Burdge RE: Neurological complications resulting from supracondylar fractures of the humerus in children. J Pediatr Orthop 1986; 6(6): 647-50.

  45. Millis MB, Singer IJ, Hall JE: Supracondylar fracture of the humerus in children. Further experience with a study in orthopaedic decision-making. Clin Orthop 1984; (188): 90-7.

  46. Minkowitz B, Busch MT: Supracondylar humerus fractures. Current trends and controversies. Orthop Clin North Am 1994; 25(4): 581-94.

  47. Morrissy RT, Wilkins KE: Deformity following distal humeral fracture in childhood. J Bone Joint Surg [Am] 1984; 66(4): 557-62.

  48. Nacht JL, Ecker ML, Chung SM, Lotke PA, Das M: Supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning. Clin Orthop 1983; (177): 203-9.

  49. Onwuanyi ON, Nwobi DG: Evaluation of the stability of pin configuration in K-wire fixation of displaced supracondylar fractures in children. Int Surg 1998; 83(3): 271-4.

  50. Ormandy L: Olecranon screw for skeletal traction of the humerus. Am J Surg 1974; 127(5): 615-6.

  51. Palmer EE, Niemann KM, Vesely D, Armstrong JH: Supracondylar fracture of the humerus in children. J Bone Joint Surg [Am] 1978; 60(5): 653-6.

  52. Paradis G, Lavallee P, Gagnon N, Lemire L: Supracondylar fractures of the humerus in children. Technique and results of crossed percutaneous K-wire fixation. Clin Orthop 1993; (297): 231-7.

  53. Piggot J, Graham HK, McCoy GF: Supracondylar fractures of the humerus in children. Treatment by straight lateral traction. J Bone Joint Surg [Br] 1986; 68(4): 577-83.

  54. Pirone AM, Graham HK, Krajbich JI: Management of displaced extension-type supracondylar fractures of the humerus in children. J Bone Joint Surg [Am] 1988; 70(5): 641-50.

  55. Pravot P, Lascombes J: Fractures supracondilienes de l’humerus de l’enfant traitement par enbrochaje desendant. Arch Chir Ortop 1990; 76(3): 191-97.

  56. Ramsey RH, Griz J: Immediate open reduction and internal fixation of severely displaced supracondylar fractures of the humerus in children. Clin Orthop 1973; 90: 131-2.

  57. Rasool MN: Ulnar nerve injury after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop 1998; 18(5): 686-90.

  58. Royce RO, Dutkowsky JP, Kasser JR, Rand FR: Neurologic complications after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop 1991; 11(2): 191-4.

  59. Sabharwal S, Tredwell SJ, Beauchamp RD, Mackenzie WG, Jakubec DM, Cairns R, LeBlanc JG: Management of pulseless pink hand in pediatric supracondylar fractures of humerus. J Pediatr Orthop 1997; 17(3): 303-10.

  60. Sairyo K, Henmi T, Kanematsu Y, Nakano S, Kajikawa T: Radial nerve palsy associated with slightly angulated pediatric supracondylar humerus fracture. J Orthop Trauma 1997; 11(3): 227-9.

  61. Shaw BA, Kasser JR, Emans JB, Rand FF: Management of vascular injuries in displaced supracondylar humerus fractures without arteriography. J Orthop Trauma 1990; 4(1): 25-9.

  62. Smith FML: Children’s elbow injuries: fractures and dislocations. Clin Orthop 1967; 50: 7-30.

  63. Smith L: Deformity following supracondylar fractures of the humerus. J Bone Joint Surg 1960; 42-A: 235-252.

  64. Spinner M, Schreiber SN: Anterior interosseous-nerve paralysis as a complication of supracondylar fractures of the humerus in children. J Bone Joint Surg [Am] 1969; 51(8): 1584-90.

  65. Stanitski CL, Micheli LJ: Simultaneous ipsilateral fractures of the arm and forearm in children. Clin Orthop 1980; (153): 218-22.

  66. Swenson AL: The treatment of supracondylar fractures of the humerus by Kirschner-wire transfixion. J Bone Joint Surg 1948, 30-A: 993.

  67. Tachdjian MO: Fracturas y luxaciones en Ortopedia Pediátrica, editor Tachdjian MO, México D.F., Nueva Editorial Interamericana, 1990: 3288-3331.

  68. Topping RE, Blanco JS, Davis TJ: Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures. J Pediatr Orthop 1995; 15(4): 435-9.

  69. Vasli LR: Diagnosis of vascular injury in children with supracondylar fractures of the humerus. Injury 1988; 19(1): 11-3.

  70. Weiland AJ, Meyer S, Tolo VT, Berg HL, Mueller J: Surgical treatment of displaced supracondylar fractures of the humerus in children. Analysis of fifty-two cases followed for five to fifteen years. J Bone Joint Surg [Am] 1978; 60(5): 657-61.

  71. Williamson DM, Cole WG: Flexion supracondylar fractures of the humerus in children: treatment by manipulation and extension cast. Injury 1991; 22(6): 451-5

  72. Wilkins KE: Supracondylar fractures: what’s new? J Pediatr Orthop B 1997; (2): 110-6.

  73. Worlock PH, Colton CL: Displaced supracondylar fractures of the humerus in children treated by overhead olecranon traction. Injury 1984; 15(5): 316-21.

  74. Zionts LE, McKellop HA, Hathaway R: Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am 1994; 76(2): 253-6.




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