Lateral versus cross pinning in paediatric supracondylar humerus fractures: a meta-analysis of randomized control trials

BackgroundResults Supracondylar humerus fractures are common in children. Percutaneous pinning remains the mainstay in treatment; however, there is lack of consensus on the optimal configuration: lateral-only pinning or cross pinning. This study aims to investigate the differences in clinical and surgical outcomes between lateral-only and cross-pinning paediatric supracondylar humerus fractures. Methods A systematic search was performed using Medline Ovid, Embase and Cochrane databases for relevant randomized control trials comparing lateral and cross pinning of paediatric supracondylar humerus fractures, reporting at least one of the following: rate of iatrogenic ulnar nerve injury, loss of reduction, infection, loss of Baumann's angle and loss of carrying angle. Statistical analysis was performed using STATA 13.0. Eleven suitable randomized control trials involving 900 patients were reviewed. Loss of reduction was more common with lateral pinning (relative risk 1.44, 95% confidence interval 1.04-2.00, P = 0.027). Iatrogenic ulnar nerve injury was less common in lateral pinning with treatment-based analysis (relative risk 0.36, 95% confidence interval 0.14-0.92, P = 0.032). There was no statistically significant difference in loss of carrying angle, loss of Baumann angle or rate of infection. Conclusion Cross pinning provides superior stability in the treatment of supracondylar humerus fractures in children; however, it carries greater risk of iatrogenic ulnar nerve injury.

Automated summary

This study compared the clinical and surgical outcomes of lateral-only and cross-pinning in pediatric supracondylar humerus fractures, finding that cross pinning provides better stability but carries a higher risk of iatrogenic nerve injury.