Meta-analysis of pinning in supracondylar fracture of the humerus in children

Abstract

Objectives: The purpose of this study was to compare the outcomes of lateral pinning versus cross pinning in pediatric supracondylar humerus fractures.

Data sources: The Cochrane library, MEDLINE, CINAHL, specific orthopaedic journals, abstracts/papers from conferences and meetings, and reference lists of articles were searched from inception to September 2007.

Study selection: All randomized controlled trials and cohort studies comparing outcomes (ie, loss of fixation, iatrogenic ulnar nerve injury, and Flynn criteria) between crossed and lateral pinning were identified.

Data extraction: Two authors independently assessed methodological quality and extracted data by using a standardized data extraction form.

Data synthesis: Heterogeneity among studies was assessed using the Q test. Pooled relative risk was estimated using the Mantel-Haenszel method. Eighteen of 1829 studies were included with 1615 supracondylar fractures (837 and 778 children with cross and lateral pinning, respectively). The average age was 6.1 ± 0.9 years. The risk of iatrogenic ulnar nerve injury was 4.3 (95% confidence interval, 2.1-9.1) times higher in cross pinning compared with lateral pinning. There was no significant difference for loss of fixation, late deformity, or Flynn criteria between the two types of pinning.

Conclusions: Lateral pinning is preferable to cross pinning for fixation of pediatric supracondylar humerus fractures as a result of decreased risk of ulnar nerve injury.