1260 Journal of Clinical and Diagnostic Research. 2011 November (Suppl-1), Vol-5(6): 1260-1263 1260 Journal of Clinical and Diagnostic Research. 2011 November (Suppl-1), Vol-5(6): 1260-1263 1260 Displaced supracondylar fracture of humerus in children treated with crossed pin versus lateral pin: A Hospital based Study from Western Nepal Key Words: Supracondylar fracture, crossed pin, lateral pin ABSTRACT Background: The supracondylar fracture of the humerus is the second most common fracture in children and the most frequent one in the first decade of life. Close reduction with percutaneous pin fixation has become the treatment of choice. The success of the treatment depends on the strength of the fixation and the avoidance of complications. Crossed pin (medial and lateral pin) and two lateral parallel pin fixations after the reduction of the fracture are recommendable. Objective: To compare the efficacy of the two recommended methods of internal fixation of the displaced supracondylar fractures, Gartland’s Type II and Type III of the humerus in children. Material and Methods: This was a hospital based retrospective study which was conducted in Nepal between January 2010 and June 2011. Results: Out of the 92 patients, 56 (60.9%) were fixed with a medial lateral cross pin and 36 (39.1%) were fixed with lateral two parallel pins. The average age of the patients who were fixed with the medial lateral cross pin was 7.5± SD 2.3 years and that of those who were fixed with the lateral two parallel pins was 7.6± SD 3.0 years. 24 (26.1%) patients had type II and 68 (73.9%) had type III fractures. Conclusion: In our study, crossed pining was found to be superior to the two parallel lateral pinning; because crossed pinning had more stability. CHAKRABORTY M K, ONTA P R, SATHIAN B Orthopaedics INTRODUCTION The supracondylar fracture of the humerus occurs most commonly in children under seven years of age and it is more common in boys than in girls [1, 2]. Injuries are involved in the left or the non- dominant sites. The extension type of fracture is the most common one which is found in children [3]. The displaced supracondylar fracture of the humerus, after reduction, is fixed with pins and is immobilized in a plaster slab. The two principal configurations which have been reported in the literature for displaced supracondylar fractures are two lateral parallel pin fixation and cross (medial and lateral) pin fixation. The functional and cosmetic outcome is closely related to a successful close reduction and percutaneous pin fixation. Iatrogenic ulnar nerve injury [4], instability, redisplacement and late malunion with varus deformity are the known complications. In displaced supracondylar fracture of the humerus in children who were treated with cross pin versus lateral pin, crossed pinning was found to be biomechanically more stable [5]. MATERIAL AND METHODS This was a hospital based, retrospective study which was conducted in the Orthopaedic Department of Manipal College of Medical Sciences, Pokhara, Nepal, between January 2010 and June 2011. The variables which were collected were age, gender, crossed pin versus lateral pin, the mode of injury and the affected side. The displaced extension type supracondylar fractures in children were treated at our institute by closed reduction and percutaneous pinning. The exclusion criteriae were open fractures, fractures that required open reduction, previous epsilateral elbow fracture and the presence of any concomitant fractures in the epsilateral limb. We reviewed the hospital records of the study cohort for details which included pre-operative clinical examinations, operative note, postoperative evaluation, duration of the immobilization and the time of the pin removal. When there were complications, there was a need for further surgeries and clinical assessment at the follow up visit. A total of 92 children fulfilled the inclusion criteriae of the study, Original Article KEY MESSAGE n In cases of displaced supracondylar fractures of the humerus in children who were treated with crossed pin versus lateral pin, crossed pinning was found to be biomechanically more stable. n Pin fixation is always controversial; lateral pin fixation is not stable enough against tortional forces. n To avoid iatrogenic ulnar nerve injury in case of medial pinning, the relative extension of the elbow is done after the lateral pinning fixation. n Cross pinning has been recommended in Gartland’s Type III fractures. In cases of severe swelling, a medial incision to see the entry point of the medial pin is required to prevent the iatrogenic ulnar nerve injury.