INTRODUCTION

Supracondylar humerus fractures being the most common 
pediatric fracture around the elbow and are nearly three-

1–13fourth of all upper-extremity fractures.  Gartland's 
classication is used to describe this fractures as 
nondisplaced fractures (Type I), hinged fractures with the 
posterior cortex intact (Type II), and completely displaced 
fractures (Type III).4 Percutaneous pinning of supracondylar 
humerus fractures in children after closed reduction is an 
effective way to maintain an anatomic reduction of a 
displaced fracture till bony union and  was rst described by 

5Casiano in 1960.  Closed reduction and percutaneous 
Kirschner wire (k-wire) xation is now considered as standard 
method for surgical management of displaced extension type 
(Gartland Type II and Type III) supracondylar humerus 
fractures. Many investigators have used two crossed pins (one 

5-7introduced medially and one laterally).  Others have used 
two or three lateral pins only and without any medial pin.8 The 
optimal conguration of percutaneous pin xation is however 
still debatable.

Biomechanically, a crossed pin conguration (one medial and 
one lateral) provides increased stability but carries the risk of 
iatrogenic ulnar nerve injury during insertion of the medial 

9-11pin.  Conversely, lateral pin xation avoids the danger of 
iatrogenic ulnar nerve injury but has been proven to be 
mechanically less stable compared to crossed pin 

12-16conguration.  There are studies which have proven that 
lateral-only xation is good enough for maintaining reduction 
while simultaneously avoiding injury to the ulnar nerve.17 This 
retrospective study was conducted to nd out the outcome of 
percutaneous lateral pinning in the management of displaced 
supracondylar fracture of humerus in children, also to see the 
associated complications with this method of xation.

MATERIALS AND METHODS
This retrospective study comprising of 25 cases of displaced 
fracture supracondylar humerus, treated by lateral and cross 
pinning was carried out at Orthopedics Department, H. B. T. 
Medical College and Dr. R. N. Cooper Municipal General 

Hospital, Mumbai from July 2018 to June 2019. A written 
informed consent was obtained from all the patients (by their 
parents). The inclusion criteria was closed supracondylar 
fracture of humerus extension Type II and type III in children 
less than 14 yrs of age. Patients with a) extension Type I of 
fractures, b) exion type injuries, c) compound fractures d) 
patients completed the age of 14 years e) pervious history of 
fractures or nerve injury around elbow, were excluded from the 
study.

All the necessary preoperative work-up was done in the form 
of thorough clinical and radiological examination. The 
fractures were classied as per the Gartland's classication 
system. All patients were operated under general anesthesia 
within 48 h after trauma. Under general anesthesia, using c-
arm image intensier, closed reduction was done. The 
forearm was then pronated and the elbow acutely exed and 
held temporarily by adhesive tape. Pronation de-rotates the 
distal fragment from its frequently medially rotated position 
and locks it in correct alignment.  When satisfactory reduction 
had been achieved then xation was done by two divergent 
lateral K-wires of 1.5 or 2.0 mm size. Adequate reduction was 
assessed by anterior humeral line passing through the centre 
of capitulum. Pins were placed in divergent conguration with 
the adequate separation at the fracture site. If doubt in 
stability of xation was there, a third lateral pin was added. 
Vascularity of distal limb were also checked at this point. The 
pins were bent and cut off outside the skin and a well-padded, 
above-elbow, back-slab was applied and vascularity of the 
distal part of limb checked again. The patient was carefully 
observed for 48-72 hours with proper limb elevation and then 
discharged in above elbow POP back slab. The follow-up was 
done as follows: the rst follow-up on the 7th day to inspect pin 
tract infection and swelling; the second follow-up on the 2nd 
week to see pin tract infection and the pin conguration; the 
3rd follow-up on the 4th week for the removal of plaster slab as 
well as pins and to start physiotherapy; the 4th follow-up on 
the 8th week post-operatively to see the progress of 
rehabilitation and any other complications; and the nal 
follow-up on the 6 months post-operatively to see the nal 

FUNCTIONAL AND RADIOLOGICAL OUTCOME OF SUPRACONDYLAR 
HUMERUS FRACTURES IN CHILDREN WITH LATERAL PINNING: A 

RETROSPECTIVE ANALYSIS

Original Research Paper

Ganesh R. 
Yeotiwad

Assistant Professor, H.B.T. Medical college and Dr.R.N. Cooper Hospital, 
Mumbai, Maharashtra-400056

Orthopaedics

Supracondylar humerus fractures being the most common pediatric fracture around the elbow. Closed 
reduction and percutaneous Kirschner wire (k-wire) xation is now considered as standard method for 

surgical management of displaced fractures. The optimal conguration of percutaneous pin xation is however still debatable. 
This study was conducted to nd out the outcome of percutaneous lateral pinning in the management these fractures. Functional 
outcome was calculated as per Flynn's criteria. Total of 25 cases were studied, out of which, 20 (80 %) had excellent, 4 (16 %) had 
good, 1 (4 %) had fair outcome. No poor outcome at the nal follow-up of 6 months. No case postoperative of ulnar nerve palsy 
was seen. We conclude that closed reduction and xation of Gartland type II and III  paediatric supracondylar fractures with 
lateral pinning is safe and effective without the risk of iatrogenic ulnar nerve injury.

ABSTRACT

KEYWORDS : Supracondylar humerus, paediatric fracture, Flynn's criteria, lateral pinning

Harshad G. 
Argekar

Associate Professor, H.B.T. Medical college and Dr. R. N. Cooper 
Hospital,Mumbai, Maharashtra-400053

Sagar G. Daliya*
Post-graduation student, H.B.T. Medical college and Dr. R. N. Cooper 
Hospital,Mumbai, Maharashtra-400056*Corresponding Author

Chintan S. Vaidya
Post-graduation student, H.B.T. Medical college and Dr. R. N. Cooper 
Hospital,Mumbai, Maharashtra-400056

VOLUME-8, ISSUE-9, SEPTEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

110 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS



result of the study. The nal results were analyzed using the 
Flynn criteria.  This criteria is divided into two components, 
the functional and the cosmetic component and both are 
further sub-divided as excellent, good, moderate and poor at 
an interval of ve degrees. 

RESULTS
There were 25 children in this study, 15 children were male and 
10 children were females. The children were aged 1.5 years to 
13 years with median age of 7.28 years.(Table 1) There were 14 
left sided and 11 right-sided fractures. 18 children had injury 
while playing, 3 children had met with a road trafc accident 
and 4 had a fall from a height. All were closed fractures. The 
extension type II were 10 and 15 were of extension type III. 21 
cases were treated by two divergent lateral k-wires while 4 
cases were treated with three divergent lateral k wires. None of 
the fractures required open reduction. Pre-operatively, there 
were no cases of vascular or nerve injuries. During follow-up, 
none had secondary displacement of wires and loss of 
reduction. Post-operatively, 2 patients got pin tract infection, 
which was supercial and healed after removing pins and 
oral antibiotic administration. Postoperatively, no ulnar nerve 
injury or vascular injury were noted in any patients. Callus 
formation was seen in all patients at the 4th week 
postoperatively follow up before removing the K-wires. No 
case of nonunion was seen. Results were analyzed using 

7Flynn's criteria (Table 2).

TABLE 1: DISTRIBUTION OF PATIENTS AS PER AGE AND 
SEX

TABLE 2: FLYNN ET AL. CRITERIA FOR GRADING

All patients were followed at 8 weeks and 6 month post-
operatively. Functional outcome, as per Flynn's criteria, 18 (72 
%) had excellent, 4 (16 %) good, 2 (8 %) fair and 1(4 %) poor 
results at 8 weeks, which was improved to 20 (80 %) excellent, 4 
(16 %) good, 1 (4 %) fair and no poor result at the nal follow-
up of 6 months (Table 3). The average loss of range of 
movement as well as carrying angle was of 4 degrees.

Table 3: Final results of lateral K-wire xation of supracond 
ylar fracture humerus

During this study, complications like vascular injury, 
compartment syndrome, myositis ossications, ulnar nerve 
palsy, signicant mal-union and non-union were not seen.

DISCUSSION
Closed reduction and percutaneous pin xation for the 
management of pediatric supracondylar humerus fractures is 

widely accepted and practiced, but the optimal pin 
1,19–21conguration is still controversial.  Chakraborty et al. and 

Balakumar and Madhuri found crossed (medial/lateral) 
pinning to be superior than two parallel lateral pin 

22,23xations.  However, many studies have reinforced the 
observation that both lateral-entry pin xation and crossed 
pin conguration are effective in the management of Type III 

21,24,25Gartland supracondylar fractures in children.

26Sankar et al.  studied the loss of pin xation in supracondylar 
humerus fractures. He concluded in all cases, loss of xation 
was due to technical errors that were identiable during 
intraoperative uoroscopic images. All these errors could 
have been prevented with proper reduction and xation 
technique. Three types of of pin-xation errors were identied 
as: (1) failure to achieve bicortical xation with two pins or 
more, (2) failure to engage both fragments with two pins or 
more, and (3) failure to achieve adequate pin separation (>2 
mm) at the fracture site. 

27Sapkota et al.  suggested lateral pinning with 2 or 3 K-wires 
for proper stabilization and ideal conguration to be 
divergent to hold medial and lateral columns as the treatment 
of supracondylar fracture without risk of iatrogenic ulnar 
nerve injury.  Pathania et al. studied the surgical 
complications and also compared the functional and 
radiological result of lateral pinning and crossed pinning in 
supracondylar fractures in children. They concluded that 
xation of supracondylar humerus fracture of Gartland type II 
and III can be done by both ways either cross or lateral 
pinning but in view of ulnar nerve injury and extension lag 
which is more commonly associated with cross pinning, 
lateral pinning is comparatively safe and reliable for both 

28types of supracondylar fractures of humerus in children.

Govindasamy et al. did a retrospective study on Cross pinning 
versus lateral pinning in supracondylar fracture in children 
and concluded that both xation techniques were good in 
terms of stability, function and cosmetic outcome. The problem 
with cross pinning was iatrogenic ulnar nerve injury due to 
medial pinning which was 11%. So lateral pinning is reliably 
safe method and provides adequate stability in displaced 

29supracondylar fractures.
 

17Skaggs et al.  concluded that lateral-only pins provide 
adequate stability without endangering the ulnar nerve for 
xation of both Type II and III supracondylar humerus 
fractures. They also advised avoiding the regular use of 
crossed pins in the treatment of pediatric supracondylar 
humerus fractures. In our study also, we found that lateral 2-3 
pins were enough to provide a stable xation and give 
excellent to good functional and radiological outcome without 
any risk of ulnar nerve injury.

CONCLUSION
As the xation remained stable with lateral pinning and 
provided excellent to fair functional as well as cosmetic 
outcome with no loss of reduction during follow up, it can be 
concluded that closed reduction and xation of Gartland type 
II and III supracondylar fractures with lateral pinning is safe 
and effective without the risk of iatrogenic ulnar nerve injury.

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