Outcomes of Percutaneous Medial-Lateral Cross Pinning of the Pediatric Supracondylar Fractures of the Humerus

Introduction: Supracondylar fracture of distal humerus is the commonest pediatric fractures around the elbow. Treatment options range from non-operative to the closed or open reduction of the fracture and percutaneous Kirchner-wire (K-wire) fixation depending upon fracture and patient variables and expertise available. There are various patterns of percutaneous K-wire fixations described by different authors. The rate of traumatic and iatrogenic ulnar nerve injuries following pediatric supracondylar fractures of the humerus ranges from 12% to 20% and 2% to 6% respectively. The present study is aimed at determining the various outcomes in patients with pediatric supracondylar fractures of the humerus treated by close reduction and a medial-lateral percutaneous K-wire fixation. Materials and Methods: Thirty five children with Gartland Type II and III supracondylar fracture of humerus were treated between February 2009 and December 2014 by closed reduction and percutaneous medial-lateral cross K-wire fixation. There were 22 male and 13 female children. Mean age of the children was 6.9 years (range 3-15 years) Extra care was taken to identify and secure the ulnar nerve while inserting the medial pin. All the patients were followed for a mean period of 9.4 months (range 6-13 months). Results: Union was seen in all patients (100%) at a mean interval of 4.5 weeks (range 3-5 weeks). One patient (2.9%) had varus union. Superficial pin tract infection was seen in 5 (14.2%) patients. None of the patients has a pre-operative ulnar nerve injury, while 1 (2.9%) patient had iatrogenic ulnar nerve neurapraxia. Based on Flynn's criteria 85.6% patients had good to excellent results, 8.6% patients had fair results while 5.8% had poor results. Conclusion: Pediatric supracondylar fractures can be satisfactorily treated by close reduction and percutaneous medial-lateral cross K-wire fixation without any undue risk of ulnar nerve injury.