Mannan Muhammad, Eisha Shahzeen, Afridi Asif
Orthopedic Surgery, University Hospital Birmingham, Birmingham, GBR.
Orthopedics and Trauma, Sheikh Zayed Medical College, Rahim Yar Khan, PAK.
Cureus. 2024 Sep 28;16(9):e70404. doi: 10.7759/cureus.70404. eCollection 2024 Sep.
Supracondylar fracture of the humerus (SCFH) is a common pediatric fracture encountered in orthopedic surgery. The most frequently used pinning methods include cross pinning or lateral pinning with two or three pins. However, complications such as ulnar nerve injury can occur, particularly during medial pinning, which necessitates careful isolation of the ulnar nerve and expert surgical intervention. The objective of this study is to compare nerve injury in cross versus lateral pinning fixation of the SCFH.
The observational study was conducted at Sheikh Zayed Hospital, Rahim Yar Khan, PAK. Patients in group L (n=55) underwent lateral pinning, while those in group C (n=55) received cross pinning. The patients were followed retrospectively postoperatively until radiological union was achieved. The outcomes were assessed using the Flynn criteria, and nerve injury was evaluated in both groups. The study aimed to compare the postoperative results between the two groups based on the specified criteria.
The mean age was 7.28±2.03 years in group L and 8.20±2.21 years in group C. The majority of patients in both groups were male. The left side was more commonly involved, and among the 110 patients enrolled, most sustained the injury while playing. The mean follow-up period was 21.3±1.4 months for group L and 23.5±0.2 weeks for group C. Nerve injuries were reported in six (5.45%) patients in group C, while no nerve injuries were reported in group L.
For type III SCFH, lateral pinning fixation has demonstrated itself to be an effective alternative, yielding excellent functional outcomes. This method not only minimizes the risk of iatrogenic nerve injury, particularly to the ulnar nerve but also provides sufficient stability for the fracture. The results from this study suggest that lateral pinning is a reliable option for treating unstable supracondylar fractures, with a favorable safety profile and outcomes comparable to, if not better than, those achieved with cross pinning. This makes it a valuable technique, especially in settings where the risk of nerve injury is a significant concern.
肱骨髁上骨折（SCFH）是骨科手术中常见的儿童骨折。最常用的穿针固定方法包括交叉穿针或用两根或三根针进行外侧穿针。然而，可能会发生诸如尺神经损伤等并发症，尤其是在内侧穿针时，这就需要仔细分离尺神经并由专业外科医生进行干预。本研究的目的是比较SCFH交叉穿针与外侧穿针固定时的神经损伤情况。
本观察性研究在巴基斯坦拉希姆亚尔汗的谢赫扎耶德医院进行。L组（n = 55）患者接受外侧穿针，而C组（n = 55）患者接受交叉穿针。对患者进行术后回顾性随访，直至达到影像学骨愈合。使用弗林标准评估结果，并对两组患者的神经损伤情况进行评估。本研究旨在根据指定标准比较两组的术后结果。
L组患者的平均年龄为7.28±2.03岁，C组为8.20±2.21岁。两组中的大多数患者为男性。左侧更常受累，在纳入的110例患者中，大多数在玩耍时受伤。L组的平均随访期为21.3±1.4个月，C组为23.5±0.2周。C组有6例（5.45%）患者报告有神经损伤，而L组未报告有神经损伤。
对于III型SCFH，外侧穿针固定已证明是一种有效的替代方法，可产生优异的功能结果。这种方法不仅将医源性神经损伤的风险降至最低，尤其是对尺神经的损伤，而且为骨折提供了足够的稳定性。本研究结果表明，外侧穿针是治疗不稳定髁上骨折的可靠选择，具有良好的安全性，其结果即使不比交叉穿针更好，也与之相当。这使其成为一种有价值的技术，尤其是在神经损伤风险是一个重大问题的情况下。
