COMPARISON OF OUTCOME OF

SUPRACONDYLAR FRACTURES OF
HUMERUS IN CHILDREN TREATED
WITH CROSS PINNING AND LATERAL
PINNING
A Presentation by Dr. Prashant Gupta
PG Trainee, JLN Medical College, Ajmer
Guide: Dr. Hemeshwar Harshwardhan
Professor & Head, Dept. of Orthopedics,
JLN Medical College, Ajmer
 • Supracondylar fractures of humerus are
INTRODUCTION
the most common elbow injury in
children and make up approximately
60% of all elbow injuries.
• The high incidence of residual deformity
and the potential for neurovascular
complications make supracondylar
humeral fractures a serious injury.
• Great diligence is required to secure an
excellent result and to avoid
complications such as malunion,
stiffness, permanent nerve injuries and
myositis ossification.
AIMS & OBJECTIVE

To compare the functional outcomes of

supracondylar fractures of the humerus in
children treated with cross pinning and
lateral pinning
MODIFIED GARTLAND
CLASSIFICATION
MATERIALS & METHOD

Department of Orthopaedics,JLN Medical College

Location:
& Hospital , Ajmer

Duration: From December 2018 to June 2020

Type of Study: Prospective

Follow Up Period: 6 months

CRITERIA

INCLUSION • Age between three to twelve years.

CRITERIA
• Those presented within 0 to 7 days.

• Age less than three years and more then twelve

EXCLUSION years.
CRITERIA
• Undisplaced fractures
• Pathological Fractures
SURGICAL TECHNIQUE

• Prior to reduction, a careful inspection of the

soft tissues is performed to look for:
• Degree of swelling
• Tethering of the dermis over the humeral shaft
(“pucker sign”)

• A period of gentle but sustained traction is

maintained for 5-10 minutes.
SURGICAL TECHNIQUE

Angulation and translation are

corrected by direct manipulation.
With the elbow initially extended, a
thumb is positioned over the olecranon
and pushed distally and anteriorly,
whilst the elbow is smoothly flexed.
The reduction is verified on AP and
lateral views
SURGICAL TECHNIQUE

For Lateral Pinning

The first K-wire is inserted within the lateral column and should
achieve strong purchase in the medial cortex of the proximal
fragment. The second K-wire is inserted from the lateral side
into the medial column. The pin spread at the fracture site
should be more than 1/3 of the bone diameter.

For Cross Pinning

The first lateral pin is inserted as described above. Then the
elbow is semi-flexed and medial epicondyle is palpated, and a
1 cm longitudinal skin incision is made directly over the
prominence of the medial epicondyle. The K-wire is inserted
through the medial epicondyle and across the fracture in the
medial column.
 Age Distribution Distribution according to type
9 3% 6%
8
8
7
6 6 Type 1
6 Type 2
OBSERVATIONS & RESULTS

5 Type 3
Type 4
4
3 3 Flexion
3
2 2
2
1 1
1
91%
0
4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years

Distribution according to Sex Distribution Displacement in Type 3

side Fractures

Left 24% Posteromedial

34%
41% Right Posterolateral
Males
Females
59%
66%
76%
 Type Of Pinning Time For Radiological Union
10
9
8
7
6
5
4
Cross
OBSERVATIONS & RESULTS

47% Lateral 2
53% 1
0
< 4 weeks 4 weeks 5 weeks 6 weeks >6 weeks

Cross Piining Lateral Pinning

Avg. time for radiological union was 4.6 weeks in cross

pinning group and 4.7 weeks in lateral pining group.

Loss of ROM Loss of Carrying Angle

12 16
14
10
12
8
10
6 8
6
4
4
2
2
0 0
0-5° 6-10° 11-15° >15° 0-5° 6-10° 11-15° >15°

Cross Lateral Cross Lateral

Mean loss of ROM in cross pinning group was 10.35 Mean loss of CA in cross pinning group was 3.4 degrees
degrees while in lateral pinning group was 10.53 degrees while in lateral pinning group was 4.1 degrees.
 Change in Baumann Angle Infection
12

10
• 4 patients in cross pinning group and 3 patients in
8

6 lateral pinning group had superficial infection at 4

4
weeks of follow-up.
OBSERVATIONS & RESULTS

0
<6° 6-12° >12° • Infection resolved after removal of pins and none of
Cross Lateral
the patients had infection at subsequent follow-up.
Average change in Baumann angle in Cross pinning group
• None of the patients developed deep infection at
was 5.2° while in Lateral Pinning group was 6.1°.
any time during follow-up

Nerve Palsy
According to Skaggs’s Grading, 11 patients in cross
1 patient in Cross pinning group developed ulnar nerve
pinning group and 6 patients in lateral pinning group had
no displacement. 6 patients in cross pinning group and 9 palsy after surgery that resolved at 3 months of follow
patients in lateral pinning group had mild displacement.
up. No patient in Lateral pinning group developed any
No patient in either group had major displacement.
kind of nerve palsy.
EVALUATION OF OUTCOME
FLYNN’S FUNCTIONAL FLYNN’S COSMETIC
CRITERIA CRITERIA

Functional Criteria Functional Criteria

12 16
14
10
12
8
10
6 8
6
4
4
2
2
0 0
Excellent Good Fair Poor Excellent Good Fair Poor

Cross Lateral Cross Lateral

In cross pinning group, 16 patients (94.1%)

In cross pinning group, 16 patients (94.1%)
had satisfactory results (15 excellent, 1
had satisfactory results (1 excellent, 11 good,
good) and 1 patient had poor result while
4 fair) and 1 patient had poor result while in
in lateral pinning group 14 patients
lateral pinning group 13 patients (86.7%) had
(93.3%) had satisfactory results (9
satisfactory results (1 excellent, 9 good, 3
excellent, 5 good) and 1 patient had poor
fair) and 1 patient had poor result.
result.
EVALUATION OF OUTCOME –
CROSS PINNING

Immediate Post-op X-Ray Pre-op X-Ray

Follow up X-rat at 6 month

ROM after 6 Months
EVALUATION OF OUTCOME –
LATERAL PINNING

Immediate Post-op X-Ray Pre-op X-Ray

Follow up at 6 month
Range of Motion after 6 Months
CONCLUSION

In our study, we observed that closed reduction and

percutaneous pinning is an excellent method of treatment of
displaced supracondylar fractures in children.
Cross pinning these fractures, with careful technique which
safeguards the ulnar nerve gives excellent results
CONCLUSION

Lateral pinning is an equally good treatment choice especially

for the grossly swollen elbows in which the medial epicondyle
in barely palpable with increased risk of ulnar nerve injury
during the placement of the medial pin.
Both the methods offer consistently satisfactory functional and
cosmetic results.
 THANK YOU !

Dr. Prashant Gupta

JLN Medical College, Ajmer
marvelousprashant@gmail.com /
8368170895