Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis
Abstract Background The standard treatment for severe displaced pediatric supracondylar humeral fracture (SCHF) is closed reduction and percutaneous pin fixation. However, controversy persists concerning the optimal pin fixation technique. The purpose of this study was to compare the safety and effi...
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| Format: | Article |
| Language: | English |
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BMC
2018-04-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-018-0768-3 |
| _version_ | 1798002606794080256 |
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| author | Yuyan Na Rui Bai Zhenqun Zhao Changxu Han Lingyue Kong Yizhong Ren Wanlin Liu |
| author_facet | Yuyan Na Rui Bai Zhenqun Zhao Changxu Han Lingyue Kong Yizhong Ren Wanlin Liu |
| author_sort | Yuyan Na |
| collection | DOAJ |
| description | Abstract Background The standard treatment for severe displaced pediatric supracondylar humeral fracture (SCHF) is closed reduction and percutaneous pin fixation. However, controversy persists concerning the optimal pin fixation technique. The purpose of this study was to compare the safety and efficacy on the configuration of lateral entry only with crossed entry pin fixation for SCHF, including Gartland type II and type III fractures in children. Methods Published literatures, including retrospective studies, prospective studies, and randomized controlled trials, presenting the probability of poor functional consequence of elbow and/or loss of reduction and/or iatrogenic ulnar nerve injury and/or superficial infection and/or cubitus varus were included. Statistical analysis was performed with the Review Manager 5.3 software. Results Twenty-four studies were included in the present meta-analysis involving 1163 patients with lateral entry pins and 1059 patients with crossed entry pins. An excellent score of Flynn criteria occurred more commonly in patients who treated with crossed pins than in patients with lateral pins only (RR = 0.93; 95% CI 0.87–0.99; P = 0.03). In accordance with previous systematic review, the incidence of iatrogenic ulnar nerve injury in crossed entry group was significantly more than in lateral entry group with statistical difference (RR = 0.26; 95% CI 0.14–0.47; P < 0.0001). And, results of subgroup analysis on iatrogenic ulnar nerve injury based on experimental design of retrospective study (RR = 0.23; 95% CI 0.10–0.52; P < 0.0004) and randomized control trial (RR = 0.29; 95% CI 0.10–0.79; P < 0.02) were similar. Conclusions In consideration of the contradictoriness of lateral entry with two pins only (possible risk of poor functional consequence of elbow) and crossed entry pins (risk of iatrogenic ulnar nerve injury), the recommended strategy for the treatment of SCHF is the lateral entry technique with introducing divergent three pins which can provide a stable configuration and avoid the injury of the ulnar nerve. And additional protective measures for the ulnar nerve should be taken by surgeons that wish for the more stable structure with the crossed entry technique. |
| first_indexed | 2024-04-11T11:55:01Z |
| format | Article |
| id | doaj.art-350eabe58e284f34bfbc0d57be895954 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T11:55:01Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-350eabe58e284f34bfbc0d57be8959542022-12-22T04:25:11ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2018-04-011311810.1186/s13018-018-0768-3Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysisYuyan Na0Rui Bai1Zhenqun Zhao2Changxu Han3Lingyue Kong4Yizhong Ren5Wanlin Liu6Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical UniversityDepartment of Pediatric Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical UniversityDepartment of Pediatric Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical UniversityDepartment of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical UniversityDepartment of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical UniversityDepartment of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical UniversityDepartment of Pediatric Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical UniversityAbstract Background The standard treatment for severe displaced pediatric supracondylar humeral fracture (SCHF) is closed reduction and percutaneous pin fixation. However, controversy persists concerning the optimal pin fixation technique. The purpose of this study was to compare the safety and efficacy on the configuration of lateral entry only with crossed entry pin fixation for SCHF, including Gartland type II and type III fractures in children. Methods Published literatures, including retrospective studies, prospective studies, and randomized controlled trials, presenting the probability of poor functional consequence of elbow and/or loss of reduction and/or iatrogenic ulnar nerve injury and/or superficial infection and/or cubitus varus were included. Statistical analysis was performed with the Review Manager 5.3 software. Results Twenty-four studies were included in the present meta-analysis involving 1163 patients with lateral entry pins and 1059 patients with crossed entry pins. An excellent score of Flynn criteria occurred more commonly in patients who treated with crossed pins than in patients with lateral pins only (RR = 0.93; 95% CI 0.87–0.99; P = 0.03). In accordance with previous systematic review, the incidence of iatrogenic ulnar nerve injury in crossed entry group was significantly more than in lateral entry group with statistical difference (RR = 0.26; 95% CI 0.14–0.47; P < 0.0001). And, results of subgroup analysis on iatrogenic ulnar nerve injury based on experimental design of retrospective study (RR = 0.23; 95% CI 0.10–0.52; P < 0.0004) and randomized control trial (RR = 0.29; 95% CI 0.10–0.79; P < 0.02) were similar. Conclusions In consideration of the contradictoriness of lateral entry with two pins only (possible risk of poor functional consequence of elbow) and crossed entry pins (risk of iatrogenic ulnar nerve injury), the recommended strategy for the treatment of SCHF is the lateral entry technique with introducing divergent three pins which can provide a stable configuration and avoid the injury of the ulnar nerve. And additional protective measures for the ulnar nerve should be taken by surgeons that wish for the more stable structure with the crossed entry technique.http://link.springer.com/article/10.1186/s13018-018-0768-3Supracondylar humeral fracturePediatricPin fixation |
| spellingShingle | Yuyan Na Rui Bai Zhenqun Zhao Changxu Han Lingyue Kong Yizhong Ren Wanlin Liu Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis Journal of Orthopaedic Surgery and Research Supracondylar humeral fracture Pediatric Pin fixation |
| title | Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis |
| title_full | Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis |
| title_fullStr | Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis |
| title_full_unstemmed | Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis |
| title_short | Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis |
| title_sort | comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures a meta analysis |
| topic | Supracondylar humeral fracture Pediatric Pin fixation |
| url | http://link.springer.com/article/10.1186/s13018-018-0768-3 |
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