A Systematic Review of Medial and Lateral Entry Pinning Versus Lateral Entry Pinning for Supracondylar Fractures of the Humerus

Document Type : Original Article

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Department of Orthopedic Surgery, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt.

Abstract

Background: Some authors propose lateral entrance pins alone after closed reduction, while others recommend medial/lateral pins that include one medial and one lateral.
Aim of the study: This study aims to detect association between iatrogenic nerve injury and surgical treatment of types II and III supracondylar fractures with medial/lateral or lateral entry pins.
Patients and Methods: A search strategy was formulated firstly then we used it on different databases such as PubMed, Web of Science, Cochrane Library, and Scopus to reach the studies compared the Medial and Lateral Entry Pinning and Lateral Entry Pinning. Screening was done followed by data extraction and statistical analysis of the outcomes.
Results: Success rate was reported in only four studies counting for 232 [84.9%] of 273 in the crossed pinning entry compared to 399 [84.8%] of 470 in the lateral pinning entry. The pooled odds OR showed no significant difference [OR = 1.04, 95% CI [0.82 to 1.31], P= 0.77]. Iatrogenic ulnar nerve injury was the most common problem reported in 20 studies of the 27 studies included in this meta-analysis. The data were pooled across all 20 studies, and the pooled OR revealed a significant higher incidence of the crossed pinning entry occurring in 37 [4.36%] of 849 children allocated whereas the iatrogenic ulnar nerve injury was occurred in 10 [1.03%] of 967 children allocated to the lateral pinning entry [OR= 2.07, 95% CI [1.07 to 3.98], P=0.03].
Conclusion: The most reliable method is to use medial/lateral entry pins, while being cautious to prevent any nerve damage caused by medical intervention, regardless of the chosen treatment methodology.

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