Journal of pediatric orthopedics · 2012
Treatment of displaced pediatric supracondylar humerus fracture patterns requiring medial fixation: a reliable and safer cross-pinning technique.
Сравнительное исследованиеСтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Edmonds Eric W, Roocroft Joanna H, Mubarak Scott J
Аннотация
INTRODUCTION: Treatment of displaced Gartland type 3 supracondylar humerus fractures in children may include closed reduction and percutaneous pinning. The pin configuration may be all-lateral entry or cross-pin. Despite the improved stability possible with cross-pinning, there is an inherent iatrogenic risk to the ulnar nerve of about 6%. As medial fixation may be necessary for certain fracture patterns, this study was conducted to evaluate the risk of ulnar neuropathy using a technique here described and developed to minimize injury to this structure.
METHODS: A retrospective review was performed on all children treated for a supracondylar humerus fracture at our institution between 2003 and 2010. All the type 3 displaced fractures were placed into 2 groups: lateral-entry pinning and cross-pinning. The 2 groups were then compared for risk of ulnar nerve injury, and a post hoc power analysis was performed.
RESULTS: A total of 381 supracondylar humerus fractures met the inclusion criteria. Our cross-pinning technique was used in 187 (49%) of the children with a mean age of 5.8 years (range, 0.92 to 13.92 y). There were 4 ulnar nerve injuries in the entire cohort and 2 sustained as iatrogenic injuries in the cross-pinning group (1.1%). There was no significant difference between our 2 groups in regard to risk of ulnar nerve injury (P=0.24). There is a statistically significant lower risk of ulnar nerve injury in our cross-pinning technique than previously described techniques (P=0.0028), with a post hoc power analysis of 93%.
CONCLUSIONS: Despite the inherent risk for iatrogenic nerve injury with cross-pinning completely displaced supracondylar humerus fractures, there is often a need to use this technique to improve fixation and stability of the fracture. Our method of cross-pinning is safe and reproducible for providing fracture stability with a significant decrease in the risk of iatrogenic ulnar nerve injury (1 in 94) when a medial pin is required.
LEVEL OF EVIDENCE: Level III-therapeutic studies.
METHODS: A retrospective review was performed on all children treated for a supracondylar humerus fracture at our institution between 2003 and 2010. All the type 3 displaced fractures were placed into 2 groups: lateral-entry pinning and cross-pinning. The 2 groups were then compared for risk of ulnar nerve injury, and a post hoc power analysis was performed.
RESULTS: A total of 381 supracondylar humerus fractures met the inclusion criteria. Our cross-pinning technique was used in 187 (49%) of the children with a mean age of 5.8 years (range, 0.92 to 13.92 y). There were 4 ulnar nerve injuries in the entire cohort and 2 sustained as iatrogenic injuries in the cross-pinning group (1.1%). There was no significant difference between our 2 groups in regard to risk of ulnar nerve injury (P=0.24). There is a statistically significant lower risk of ulnar nerve injury in our cross-pinning technique than previously described techniques (P=0.0028), with a post hoc power analysis of 93%.
CONCLUSIONS: Despite the inherent risk for iatrogenic nerve injury with cross-pinning completely displaced supracondylar humerus fractures, there is often a need to use this technique to improve fixation and stability of the fracture. Our method of cross-pinning is safe and reproducible for providing fracture stability with a significant decrease in the risk of iatrogenic ulnar nerve injury (1 in 94) when a medial pin is required.
LEVEL OF EVIDENCE: Level III-therapeutic studies.