December 22, 2011
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Cross pinning for supracondylar humerus fractures in children carries risk of iatrogenic ulnar nerve injuries

Woratanarat P. J Orthop Trauma. 2011. doi: 10.1097/BOT.0b013e3182143de0

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Researchers from Thailand found that cross pinning in supracondylar fractures of the humerus in children carries a higher risk of iatrogenic ulnar nerve injury than lateral pinning.

The investigators searched the Cochrane Library, CINAHL, orthopedic journals, abstracts and papers from various conferences and meetings and reference lists for randomized controlled trials and cohort studies showing outcomes between cross pinning and lateral pinning. They looked at studies comparing loss of fixation, iatrogenic ulnar nerve injury and Flynn criteria. They pinpointed 18 studies with 1,615 supracondylar fractures in children with an average age of 6 years. Outcomes measurements were the Q test for assessing heterogeneity in the studies and the Mantel-Haenszel method to calculate pooled relative risk.

The researchers found a 4.3 times higher risk of iatrogenic ulnar nerve injury in children who were cross pinned compared with children who were laterally pinned. They found no statistically significant differences between groups in terms of loss of fixation, late deformity or Flynn criteria.

“Lateral pinning is preferable to cross pinning for fixation of pediatric supracondylar humerus fractures as a result of decreased risk of ulnar nerve injury,” the authors wrote in the abstract.