Comparison of Medial/Lateral Pinning Versus All Lateral Pinning in Treatment of Pediatric Supracondylar Humerus Fractures.

Abstract

Supracondylar humerus fracture is a common elbow injury sustained in the pediatric population. Percutaneous pinning, whether all lateral or medial-lateral, is the mainstay of operative management for these injuries. There has been much debate on the safety of medial-sided pinning, with the literature indicating that medial-sided pinning can lead to iatrogenic ulnar nerve injury. Thus, the goal of our study is to describe the rates of nerve injuries (radial, median, and ulnar), loss of reduction, and range of motion between all lateral and medial-lateral treatment groups. Patients aged 1 to 18 years presenting at a pediatric hospital for a single, isolated supracondylar humerus fracture and treated with percutaneous pinning between 2018 and 2023 were reviewed. Patients with concurrent surgical treatment at the time of pinning, who presented with multiple injuries, had an open reduction, had an open fracture, or were lost to follow-up, were excluded. Age, sex, Gartland fracture classification, pinning method, nerve injury, range of motion, loss of reduction, and duration of follow-up were collected. Descriptive statistics were analyzed for variables of interest. A total of 406 pediatric patients were included. The average (SD) age at presentation was 5.7 (2.3) years, with 179 (44.1%) patients presenting with Type II fracture and 227 (55.9%) with Type III or IV. There were 131 (32.3%) patients treated with a medial-lateral pinning approach and 275 (67.7%) patients treated with an all-lateral pinning approach. Patients treated with a medial-lateral pinning experienced no new ulnar, radial, or median nerve injuries postoperatively. There was 1 (0.8%) patient with a loss of reduction, and 68.4% of patients with a medial pin had a full range of motion at their last follow-up. Patients treated with an all-lateral pinning approach experienced a new median nerve injury (n=1) and a new ulnar nerve injury (n=1) postoperatively. No patients with an all-lateral pinning approach had a loss of reduction, and 70.7% had a full range of motion at the last follow-up. This study demonstrated no occurrence of an ulnar nerve injury while utilizing the medial entry pins in the treatment of supracondylar fractures. Strict adherence to surgical principles pertaining to medial entry pins is crucial to avoid ulnar nerve injury and should be included in orthopaedic surgeon's armamentarium when treating unstable supracondylar fractures.