Although closed reduction and percutaneous pinning is the standard treatment for
the displaced pediatric supracondylar humeral fractures, controversy still exists
regarding the optimal pin configuration. The aim of this study was to compare the
outcomes of the conventional versus lateral cross-pinning (Dorgan’s technique) in
treatment of displaced pediatric supracondylar humeral fractures.
Patients and methods
A total of 50 children were randomly divided into two equal groups: group I (treated
via conventional technique) comprised 15 males and 10 female patients, with a
mean age of 5.2±2.7 years, and group II (treated via Dorgan’s technique)
comprised 17 males and eight female patients, with a mean age of 7.8±3.1
years. Preoperative and postoperative neurologic and radiological evaluations
were performed. Functional and cosmetic outcomes were evaluated according
to Flynn’s criteria. The mean follow-up periods were 25.24±7.2 and 27.56±6.3
months in groups I and II, respectively.
Results
There was no statistical significant difference between both groups regarding
patients’ and fracture characteristics, postoperative protocol, union time, and
complication rate (pin-tract infections and extensive granulation tissue formation
around Kirschner wires). The radiological, functional, and cosmetic outcomes were
satisfactory in all patients, with no statistically significant difference between both
groups. Dorgan’s technique was more time consuming than conventional crosspinning,
with no cases developing any iatrogenic neurological insult in such group;
however, iatrogenic transient ulnar nerve injury occurred in one case in group I.
Conclusion
Both cross-pinning techniques provide a biomechanically stable fixation, allowing
early and safe active elbow movements with satisfactory functional, cosmetic, and
radiological outcomes, but Dorgan’s method was more time consuming compared
with the conventional method. A properly performed Dorgan’s technique completely
avoids the risk of iatrogenic ulnar nerve injury without endangering the radial nerve.
Level of evidence: level II, randomized comparative study.