Is Prone Position Ideal for Manipulation and Pinning of Displaced Pediatric Extension-type Supracondylar Fractures of Humerus? A Randomized Control Trial.

Abstract

Closed reduction and percutaneous pin fixation is the standard of care for displaced supracondylar fractures of humerus in children. Although it is routinely performed in supine position, some authors recommend prone position to be advantageous as it aids in gravity reduction and avoids elbow hyperflexion. This study was conducted to compare the ease of manipulation and pinning, clinical, and radiologic outcomes in supine versus prone position. Fifty-two children with acute, grade III supracondylar humerus fractures without vascular injury were included in the study. They were grouped into prone (n=26) and supine (n=26) based on computer-generated block randomization. The duration of procedure, number of radiation exposures, attempts at closed reduction, and attempts at placing the pins were analyzed. Functional and radiologic outcomes were assessed for a minimum follow-up of 1 year. There was no significant difference between the 2 groups in the duration of procedure (P=0.422), number of radiation exposure (P=0.470), attempts at closed reduction (P=0.904), and attempts for pinning (P=0.745) and the final clinical and radiologic outcomes. One patient in prone group had cubitus varus of 8 degrees. Functionally, 2 in the supine group and 3 in prone group had poor outcomes. There is no significant difference in the ease of reduction and pinning between supine and prone positions. Grossly displaced fractures with skin puckering are difficult to manipulate in prone position. Supine position is ideal for closed reduction and pinning of all patterns of type III supracondylar fractures.