Mid-term clinical and radiological outcomes of patients with type III supracondylar humerus fracture treated with cross pinning versus lateral only pinning technique-A randomized study

Background: Closed reduction and percutaneous K-wire pinning is the standard management of type III supracondylar humerus fracture, however there is still lack of consensus with regards to optimal pinning technique (crossed vs lateral only pinning). The aim of the present study was to assess and compare functional and radiological outcome in these fracture patients treated with cross pinning vs lateral only pinning till mid-term follow up.

Methods: A randomized study was conducted on all eligible pediatric patients with Gartland type III supracondylar fracture treated with cross pinning (Group I, n=29) and lateral only pinning (Group II, n=31) at a single tertiary care center between February 2016 and April 2019. The continuous variables were assessed using the independent student t test while the Chi square test was used to analyze the categorical data. The Flynn’s criteria at each follow-up were assessed using the Analysis of Variance (ANOVA) test. Level of significance was set at 5% and all p-values less than 0.05 were treated as significant.

Results: A Sixty patients met the inclusion criteria with a Mean age of 6.86 ± 2.40 years. In Group I, excellent outcomes were observed in 79.3% (functional) and 75.9% (cosmetic) of patients; while in Group II, excellent outcomes were seen in 80.6% (functional) and 77.4% (cosmetic). The average surgical time in Group II (32.781 ± 11.056) was significantly less compared to that in and in Group I (42.844 ± 20.100) (t=2.481, p=0.016). No significant difference was seen with respect to functional outcome of Flynn’s criteria at final follow up, although cosmetic outcome was significantly better in Group II.

Conclusion: Both cross pinning and lateral only pinning techniques are preferable and provide stable fixation of SCH fracture with comparable outcomes. Moreover, lateral only pinning is less time consuming and avoids iatrogenic ulnar nerve injury