Title: Lateral Pinning for Supracondylar Humerus Fracture in Children: Does The Entry Point of the Pins have an Influence on the Outcome of the Fracture Fixation?
Authors: Ramachandra Badami, Swetha Purohit
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.131
Abstract
Introduction: Closed reduction with percutaneous pin fixation remains mainstay treatment for displaced supracondylar fractures. Because of documented iatrogenic ulnar nerve injury from medial pin, predilection for placement of lateral pins exist. There has been wide variation in actual starting points. Some studies favour direct lateral epicondyle, extra-articular entry, whereas others advocate capitellar or paraolecranon starting point. We studied the influence of entry point in lateral pinning on the outcome of fractures.
Materials and Methods: We studied 100 patients of Gartland type-3 supracondylar fracture humerus in children treated between March-2014 to March-2017. Patients were divided into two groups of 50 each based on K-wire entry. Group-1 included cases with direct lateral epicondyle entry and group-2 included those with capitellar entry. Radiographic outcomes were assessed based on change in Baumann angle, humerocapitellar angle. The functional results were graded as per Flynn’s criteria.
Results: There was no statistically significant difference between the groups with respect to immediate post-operative Baumann and humerocapitellar angle. But at 4wks follow up group-2 patients showed significantly better Baumann, Humerocapitellar angle (p<0.005). Mean carrying angle at final follow up was 3.4 in group-1 and 7.8 in group-2. As per Flynn criteria, 31 of 50 patients in group-1 had good to excellent results and 46 of 50 patients had good to excellent results.
Discussion: Patients in group-2 with capitellar entry of K-wires showed lesser loss of reduction, significantly better elbow range of motion and carrying angle than those with direct lateral K-wire entry. This is due to the fact that the capitellum acts as a middle column and a wire through it specifically maximizes the spread across the fracture site and engages sufficient bone in both proximal and distal fragments.
Conclusion: The capitellar starting point has stiffer construct compared with direct lateral construct hence lesser chances of loss of reduction, malunion and gives good to excellent functional outcome.
Keywords: Supracondylar, Fracture, humerus, Pinning.
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