Comparative Analysis of Postoperative Rotational Malalignment in Pediatric Supracondylar Humerus Fractures: Cross Pinning Versus Lateral Para-olecranon Pinning.

Abstract

Supracondylar humeral fractures are common in children, and are typically treated with percutaneous pinning. Cross pinning (CP) and lateral entry pinning (LP) are widely used methods. Although previous studies have focused on outcomes such as Baumann and carrying angles, research on rotational malalignment is limited. Furthermore, there have been few comparative studies on alternative surgical techniques. This study aimed to compare rotational malalignment and clinical outcomes between CP and the lateral para-olecranon pinning (LPOP) technique. This retrospective study initially identified 208 pediatric patients who underwent percutaneous pinning for supracondylar humeral fractures between 2005 and 2023. After applying the inclusion and exclusion criteria, 180 patients were included in the study and divided into 2 cohorts: LPOP (n=146) and CP (n=34). The primary outcome was corrective loss of rotation, measured radiographically at surgery and at 4 weeks postoperatively. Rotational malalignment was assessed using the formula described by Henderson and colleagues. Secondary outcomes included Baumann angle, carrying angle, tilting angle, range of motion, anesthesia, and operation times. No significant difference was found in corrective loss of rotation between LPOP and CP (θ=0.079±0.24 for LPOP vs. 0.10±0.20 for CP, P =0.57). Secondary outcomes, including the Baumann angle, carrying angle, tilting angle, and range of motion, were similar in both groups. However, the anesthesia and operation times were significantly shorter in the LPOP cohort ( P <0.01): the LPOP cohort had a shorter duration of anesthesia (124.95±32.22 min) than the CP cohort (148.21±65.72 min) ( P =0.009) and had a shorter operation time (52.02±31.56 min) than the CP cohort (71.82±43.69 min) ( P =0.006). Complication rates, including reoperations and nerve injuries, were comparable between the cohorts. Both LPOP and CP resulted in similar rotational outcomes; however, LPOP offered shorter anesthesia and surgery times without increasing the risk of complications. LPOP might be a safe and more effective alternative technique, showing equivalent clinical results and lowering the incidence of iatrogenic nerve injuries. Level III-retrospective comparative study.