Functional and radiological comparison of lateral pinning versus cross pinning in displaced pediatric supracondylar humerus fractures

Abstract

Aim: The aim of this study is to compare the commonly used cross pinning and lateral pinning techniques in the surgical treatment of pediatric supracondylar humerus fractures by evaluating clinical and radiological outcomes.

Materials and Methods: Between 2018 and 2024, patients who had surgical treatment for Gartland type 3 supracondylar humerus fractures were included in the study. Patients were divided into two groups based on the surgical technique: lateral pinning (Group 1) and cross pinning (Group 2). Patients with a minimum folloe-up of 6 months were included in the study. Demographic data inlcuidng age, sex, side, mechanism of trauma were recorded. Clinical evaluation was performed using Flynn’s criteria. Radiological evaluation included assessment of fracture union, Baumann’s angle and its change from 0 to 6 months, carrying angle, lateral humerocapitellar angle (LHCA), and its 0 to 6-month change. Complications and additional procedures were also recorded.

Results: Group 1 consisted of 32 patients, while Group 2 included 28 patients. The demographic data showed no statistically significant differences between the two groups. Based on Flynn’s criteria, outcomes in Group 1 were classified as excellent in 24 (75%) patients, good in 5 (15.6%), fair in 3 (9.4%), and none were considered poor. In Group 2, 20 (71.4%) patients achieved excellent results, 7 (25%) were rated as good, 1 as fair (3.6%), and no poor outcomes were observed. Functional outcomes were similar in both groups (p: 0.488). The groups showed comparable results in terms of both the Baumann’s angle and its change, carrying angle, LHCA and its change. Ulnar nerve injury developed in 2 patients in Group 2 and resolved with conservative follow-up.

Conclusion: In the management of pediatric supracondylar humerus fractures, lateral and cross pinning techniques yield comparable clinical and radiological results. To prevent ulnar nerve palsy in the cross-pinning technique, a mini medial incision can be used to protect the ulnar nerve.