Prevention of ulnar nerve injury during fixation of supracondylar frx by 'flexion-extension cross-pinning' technique. Loss of Pin Fixation in Displaced Supracondylar Humeral Fractures in Children: Causes and Prevention. Crossed Wires Versus 2 Lateral Wires in Management of Supracondylar Fracture of the Humerus in Children in the Hands of Junior Trainees. Cross pinning for supracondylar humerus fractures in children carries risk of iatrogenic ulnar nerve injuries 2 years after the pinning, one of the 17 children with ulnar nerve injury had persistent motor weakness and a sensory deficit medial pin was associated w/ ulnar n injury in 4% patients in whom the pin was applied w/o hyperflexion of the elbowĪnd in 15% in whom the medial pin was applied w/ elbow hyperflexed ulnar nerve injury was not seen in the 125 patients in whom only lateral pins were used configuration of the pins did not affect the maintenance of reduction of either type-2 fractures or type-3 fractures consider placing a temporary 2nd pin thru the lateral condyle to achieve even more stability insert lateral pin first to obtain stability while reduction is evaluated (avoids need to repeatedly insert medial pins if reduction is pin should avoid the olecranon fossa and should come to rest along the far cortex generally, the pin is aimed 35 deg upward and 10 deg posterior wire is inserted thru the capitellum, and then the distal humeral physis because the center of the capitellum is in line w/ anterior aspect of humeral shaft, the pin must be directed slightly posteriorly insertion point is in the center of lateral condyle (capitellum) Safe Zone for Superolateral Entry Pin Into the Distal Humerus in Children: An MRI Analysis avoid directing pins too far anterior or posterior w/ children younger than 5-6 years, use 0.062 smooth K wire pins need to be smooth w/ trochar point w/ posterolateral displacement, place arm in maximum internal rotaiton on the flourscopy platform, and insert the lateral pin first w/ posteromedial displacement, place arm in maximum external rotation on flourscopy platform, and insert the medial pin first pins should cross proximal to the frx at an angle of about 30 deg to the humeral shaft consider applying sterile "coband" to keep elbow flexed, which then allows arm to be externally rotated to achieve a lateral in preparing for crossed pinning, keep elbow hyperflexed to maintain reduction 2 lateral pins may not permit full elbow extension, thus preventing full assessment of carrying angle medial and lateral pin insertion provides better stabilization either two lateral pins, or one lateral and one medial pin may be used and both should penetrate the cortex Satisfactory outcomes measured by Flynn’s criteria were achieved in 87.74% in CRPP and 86.73% in ORIF patient group, indicating significant difference (Heterogeneity, I2 = 23% WMD, 1.26 0.58 to 2.73 P =0.56).Ĭonclusion: Current systematic review and meta-analysis suggest that for displaced supracondylar humerus fractures, ORIF offers a comparable functional and cosmetic outcome compared to CRPP.- has become standard technique for stabilizing types II & type III frx Result: Total of 252 patients aged 0-15 years old were included. In each study, mean difference (MD) with 95% confidence interval (CI) was calculated for dichotomous outcomes using Review Manager. For meta-analysis, 6 studies were included and fixed effect model used to pool the result. Studies of one surgical technique, Gartland type I, case reports were excluded. Inclusion criteria were age <18 years old, comparing CRPP and ORIF for Supracondylar Humerus Fractures Gartland Type II, II. Method: Systematic review was conducted based on PRISMA guideline. Study aims to compare CRPP and ORIF for pediatric supracondylar humerus fracture. Utilization of Closed Reduction and Percutaneus Pinning (CRPP) increased for this pathology, some authors believe ORIF results better anatomical reduction and lower rate of loss of reduction. Introduction: Displaced supracondylar fracture in children is a challenging injury that may result in impaired functional and cosmetic outcome if not well-treated.
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