Is medial pin use safe for treating pediatric supracondylar humerus fractures?

Objectives: We present a group of pediatric supracondylar humerus fractures in whom a medial pin was inserted, in addition to lateral-entry pins, and compared it with a group that was treated with lateral-only entry pins. We evaluated differences in the rate of complications related to the insertion of the medial pin.

Design: Prospective nonrandomized.

Setting: Level II academic center.

Methods: The data on 291 pediatric was analyzed. Patients in group 1 (n = 47) were treated with a combination of 2 lateral-entry pins and 1 medial-entry pin, whereas patients in group 2 (n = 244) were treated with lateral-only entry pins alone. Information related to the injury and surgical procedure was prospectively collected. The length of surgery, amount of pin separation at the fracture site, presence of neurological complications, pin tract infection, loss of fixation, final carrying angle, and range of motion were recorded.

Results: Fracture severity was similar in both groups (P = 0.6). Medial column comminution was identified preoperatively in all fractures in group 1 and in 10% of fractures in group 2. Length of surgery was a mean of 21 minutes longer for patients in group 1 (P < 0.00001). There were no iatrogenic nerve injuries, vascular complications, or compartment syndromes in either group. The use of a medial-entry pin significantly increased the amount of pin separation at the fracture site (P < 0.00001). The percentage of satisfactory results was similar in both groups (P = 0.6).

Conclusions: The results of this study suggest that the use of a medial-entry pin for the treatment of pediatric supracondylar humerus fractures is safe, if an adequate technique is followed. Although insertion of medial pins leads to longer surgeries, it does not seem to result in higher incidence of complications.