Çocuk Suprakondiler Humerus Kırıklarında Lateral ve Çapraz Pinleme Sonuçlarının Karşılaştırılması

Year 2025, Volume: 7 Issue: 2, 214 - 220, 23.06.2025

Mehmet Ekici , Muhammed Melez , Fırat Ozan

https://doi.org/10.52827/hititmedj.1572482

Abstract

Amaç: Suprakondiler humerus kırıkları (SHK), gelişimini tamamlamamış iskelette meydana gelir. Çocuklarda görülen dirsek kırıklarının %60-65’ini oluştururlar ve en sık 4-7 yaş grubunda görülürler. Bu çalışmanın amacı, pediatrik SHK’ların kapalı cerrahisinde kullanılan lateral ve çapraz pinleme yöntemlerinin radyolojik ve fonksiyonel sonuçlarını karşılaştırmaktır.
Gereç ve Yöntem: Bu çalışma, Gartland tip 2 ve 3 kırığı olan 46 hasta üzerinde yürütülmüştür. Sadece lateral pinleme uygulanan hastalar Grup 1’i, hem lateral hem de medial pinleme (çapraz pinleme) uygulanan hastalar ise Grup 2’yi oluşturmuştur. Ameliyat sonrası, 3. haftada ve 12. haftada anteroposterior ve lateral dirsek grafileri çekilmiş ve radyolojik açılar ölçülerek kaydedilmiştir. Dirsek eklemi hareket açıklığı (EHA) ameliyattan bir yıl sonra ölçülmüştür.
Bulgular: Hastaların yaş ortalaması 6,28 ± 0,44 yıldı. Baumann açısındaki azalma Grup 1’de 2,61 ± 0,36° ve Grup 2’de 2,64 ± 0,38° idi. Taşıyıcı açıda azalma Grup 1’de 0,80 ± 0,14° ve Grup 2’de 1,36 ± 0,26° idi. Lateral kapitellohumeral açıdaki (LKHA) artış Grup 1’de 5 ± 0,74° ve Grup 2’de 6,72 ± 0,93° idi. Dirsek eklemi hareket açıklığı (EHA) Grup 1’de 132,85 ± 0,76° ve Grup 2’de 132 ± 1,01° idi. Yapılan ölçümlere göre, lateral ve çapraz pin konfigürasyonları arasında radyolojik ve klinik sonuçlar açısından istatistiksel olarak anlamlı bir fark bulunmamıştır.
Sonuç: İyatrojenik ulnar sinir hasarı olasılığı göz önüne alındığında, lateral pinleme daha güvenli bir yöntem olarak değerlendirilebilir.

Keywords

Çapraz pinleme , pediatrik travma , perkütan pinleme , suprakondiler humerus

Comparison of Lateral and Cross Pinning Results in Pediatric Supracondylar Humerus Fractures

Abstract

Objective: Supracondylar humerus fractures (SHF) occur in the immature skeleton. They account for 60-65% of elbow fractures in children, with the most common age group being 4-7 years. The aim of this study is to compare the radiological and functional outcomes of lateral and cross pinning methods used in the closed surgery of pediatric SHF.
Material and Method: This study was conducted on 46 patients with Gartland type 2 and 3 fractures. Group 1 who underwent only lateral pinning, and Group 2 patients who underwent both lateral and medial pinning. Anteroposterior and lateral elbow radiographs were taken postoperatively, at 3 weeks, and at 12 weeks, and radiological angles were measured and recorded. Elbow joint ROM was measured one year after the operation.
Results: The mean age of the patients was 6.28 ± 0.44 years. The decrease in Baumann angle was 2.61 ± 0.36° in Group 1 and 2.64 ± 0.38° in Group 2. The decrease in carrying angle was 0.80 ± 0.14° in Group 1 and 1.36 ± 0.26° in Group 2. The increase in The lateral capitellohumeral angle (LCHA) was 5 ± 0.74° in Group 1 and 6.72 ± 0.93° in Group 2. The elbow joint range of motion (ROM) was 132.85 ± 0.76° in Group 1 and 132 ± 1.01° in Group 2. Based on the measurements, there was no statistically significant difference in radiological and clinical outcomes between lateral and cross pin configurations.
Conclusion: Considering the possibility of iatrogenic ulnar nerve injury, lateral pinning may be considered a safer method.

Keywords

Cross pinning , pediatric trauma , percutaneous pinning , supracondylar humerus

Ethical Statement

Approval for the study was obtained from the Kayseri City Hospital Clinical Research Ethics Committee on 12/12/2023. Decision no: 977/2023.

References

• Davis RT, Gorczyca JT, Pugh K. Supracondylar humerus fractures in children. Comparison of operative treatment methods. Clin Orthop Relat Res 2000;(376):49-55.
• Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet 1959;109(2):145-154.
• Larson L, Firoozbakhsh K, Passarelli R, Bosch P. Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. J Pediatr Orthop 2006;26(5):573-578.
• Afaque SF, Singh A, Maharjan R, Ranjan R, Panda AK, Mishra A. Comparison of clinic-radiological outcome of cross pinning versus lateral pinning for displaced supracondylar fracture of humerus in children: A randomized controlled trial. J Clin Orthop Trauma 2020;11(2):259-263.
• Eguia F, Gottlich C, Lobaton G, Vora M, Sponseller PD, Lee RJ. Mid-term Patient-reported Outcomes After Lateral Versus Crossed Pinning of Pediatric Supracondylar Humerus Fractures. J Pediatr Orthop 2020;40(7):323-328.
• Skaggs DL, Hale JM, Bassett J, Kaminsky C, Kay RM, Tolo VT. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Joint Surg Am 2001;83(5):735-740.
• Kamara A, Ji X, Liu C, Liu T, Wang E. The most stable pinning configurations in transverse supracondylar humerus fracture fixation in children: A novel three-dimensional finite element analysis of a pediatric bone model. Injury 2021;52(6):1310-1315.
• Madjar-Simic I, Talic-Tanovic A, Hadziahmetovic Z, Sarac- Hadzihalilovic A. Radiographic assessment in the treatment of supracondylar humerus fractures in children. Acta Inform Med 2012;20(3):154-159.
• Saarinen AJ, Helenius I. Paediatric supracondylar humeral fractures: the effect of the surgical specialty on the outcomes. J Child Orthop 2019;13(1):40-46.
• Kalenderer O, Reisoglu A, Surer L, Agus H. How should one treat iatrogenic ulnar injury after closed reduction and percutaneous pinning of paediatric supracondylar humeral fractures? Injury 2008;39(4):463-466.
• Rasool MN. Ulnar nerve injury after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop 1998;18(5):686-690.
• Ayas MS, Öner K. Comparison of Lateral Pinning and Cross Pinning Results in Pediatric Distal Humerus Supracondylar Gartland Type 3 Fractures. Arch Curr Med Res 2021;2(3):177-181.
• Hasan SU, Pervez A, Usmani SUR et al. Comparative analysis of pinning techniques for supracondylar humerus fractures in paediatrics: A systematic review and meta-analysis of randomized controlled trials. J Orthop 2023;44:5-11.
• Zionts LE, McKellop HA, Hathaway R. Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children. J Bone Joint Surg Am 1994;76(2):253-256.
• Naik LG, Sharma GM, Badgire KS, Qureshi F, Waghchoure C, Jain V. Cross Pinning Versus Lateral Pinning in the Management of Type III Supracondylar Humerus Fractures in Children. J Clin Diagn Res 2017;11(8)\:RC01-RC03.
• Zhao H, Xu S, Liu G, Zhao J, Wu S, Peng L. Comparison of lateral entry and crossed entry pinning for pediatric supracondylar humeral fractures: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2021;16(1):366.
• Pavone V, Riccioli M, Testa G et al. Surgical Treatment of Displaced Supracondylar Pediatric Humerus Fractures: Comparison of Two Pinning Techniques. Journal of Functional Morphology and Kinesiology 2016;1(1):39-47.
• Green DW, Widmann RF, Frank JS, Gardner MJ. Low incidence of ulnar nerve injury with crossed pin placement for pediatric supracondylar humerus fractures using a mini-open technique. J Orthop Trauma 2005;19(3):158-163.
• Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Joint Surg Am 2008;90(5):1121-1132.
• Battle J, Carmichael KD. Incidence of pin track infections in children’s fractures treated with Kirschner wire fixation. J Pediatr Orthop 2007;27(2):154-157.
• Sharma H, Taylor GR, Clarke NMP. A review of K-wire related complications in the emergency management of paediatric upper extremity trauma. Ann R Coll Surg Engl 2007;89(3):252-258.
• Prashant K, Lakhotia D, Bhattacharyya TD, Mahanta AK, Ravoof A. A comparative study of two percutaneous pinning techniques (lateral vs medial–lateral) for Gartland type III pediatric supracondylar fracture of the humerus. J Orthop Traumatol 2016;17(3):223-229.
• Kiyota Y, Suzuki T, Inaba N et al. Normal values and ranges of the lateral capitello-humeral angle in healthy children. J Pediatr Orthop B 2021;30(4):381-384.
• Karagoz B, Kibar B, Oto O, Malkoc FE. Comparision of lateral, medial, and posterior approaches in the surgical treatment of pediatric supracondylar humerus fractures. North Clin Istanb 2023;10(2):255-262.
• He M, Wang Q, Zhao J, Jin Y, Wang Y. Lateral entry pins and Slongo’s external fixation: which method is more ideal for older children with supracondylar humeral fractures? J Orthop Surg Res 2021;16(1):1-6.