A Systematic Review of Medial and Lateral Entry Pinning versus Lateral EntryPinning for Supracondylar Fractures of the Humerusin Children

Abstract

Supracondylar fractures are the most common pediatric fractures about the elbow and have a peak incidence in the first decade of life. Isolated supracondylar fractures are extraarticular, lying beyond the proximal extensions of the joint capsule. The regional anatomy includes the brachial artery and median nerve located anteriorly in the antecubital fossa, the ulnar nerve coursing posterior to the medial epicondyle, and the radial nerve anterolaterally. Injuries to these neurovascular structures have all been reported. The most commonly associated fractures are distal radial fractures, but fractures of the scaphoid and proximal humerus do occur. Supracondylar fractures generally occur as a result of a fall onto the outstretched hand with the elbow in full extension. The Gartland classification is based on the x-ray appearance of fracture displacement. Type I is a non-displaced fracture, Type II is a displaced fracture with intact posterior cortex, Type III is a displaced fracture with no cortical contact and the displacement may be posteromedial or posterolateral. Generally, medial displacement of the distal fragment is more common than lateral displacement, occurring in approximately 75% of patients in most series. Radiologic evaluation includes obtaining AP and lateral views of the entire upper extremity. Previously these fractures were treated by closed reduction with casting and traction. The primary risk with crossed pinning is injury to the ulnar nerve by a medial pin. Two or three lateral pins provide less stability than crossed pins, but there is no risk to the ulnar nerve, which is a significant benefit of this technique. Aim of the work: The objective of our systematic review is to evaluate and compare the outcome of the crossed and the lateral wiring in the treatment of supracondylar humeral fractures.