Is pin conŞguration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?

Abstract

Objective: Closed reduction with percutaneous pinning is the treatment of choice for displaced supracondylar humerus fractures in children. In addition to conŞguration of pin Şxation, many factors havebeen attributed to loss of reduction (LOR). The aim of the present study was to review potential factorsthat contribute to loss of reduction in the closed management of type III pediatric supracondylarfractures.Methods: Treatment of 87 patients with type III supracondylar fractures was reviewed to determinefactors associated with loss of reduction; 48 patients were treated with lateral pinning and 39 withcrossed-pinning after closed reduction. Outcome parameters included radiographic maintenance ofpostoperative reduction.Results: Lateral or crossed-pin conŞguration, pin spread at fracture site, pin-spread ratio (PSR), anddirection of coronal displacement of the fracture were not associated with LOR. A signiŞcant difference(p¼ 0.01) was found between LOR rates of patients with medial wall communication and LOR.Conclusion: Medial wall communication is a contributing factor to LOR in the management of type IIIsupracondylar fractures. Cross-pinning should be preferred when medial wall communication is present,to provide more stableŞxation.Level of evidence: Level IV, Therapeutic study.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)