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Surgical Techniques   |    
Lateral Entry Compared with Medial and Lateral Entry Pin Fixation for Completely Displaced Supracondylar Humeral Fractures in ChildrenSurgical Technique
Yi-Meng Yen, MD, PhD1; Mininder S. Kocher, MD, MPH1
1 Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115. E-mail address for M.S. Kocher: mininder.kocher@childrens.harvard.edu
View Disclosures and Other Information
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 89-A, pp. 706-12, April 2007
DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
The line drawings in this article are the work of Jennifer Fairman (jfairman@fairmanstudios.com).
Investigation performed at the Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2008 Mar 01;90(Supplement 2 Part 1):20-30. doi: 10.2106/JBJS.G.01337
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Abstract

BACKGROUND: Closed reduction and percutaneous pin fixation is the treatment of choice for completely displaced (type-III) extension supracondylar fractures of the humerus in children, although controversy persists regarding the optimal pin-fixation technique. The purpose of this study was to compare the efficacy of lateral entry pin fixation with that of medial and lateral entry pin fixation for the operative treatment of completely displaced extension supracondylar fractures of the humerus in children.

METHODS: This prospective, randomized clinical trial had sufficient power to detect a 10% difference in the rate of loss of reduction between the two groups. The techniques of lateral entry and medial and lateral entry pin fixation were standardized in terms of the pin location, the pin size, the incision and position of the elbow used for medial pin placement, and the postoperative course. The primary study end points were a major loss of reduction and iatrogenic ulnar nerve injury. Secondary study end points included radiographic measurements, clinical alignment, Flynn grade, elbow range of motion, function, and complications.

RESULTS: The lateral entry group (twenty-eight patients) and the medial and lateral entry group (twenty-four patients) were similar in terms of mean age, sex distribution, and preoperative displacement, comminution, and associated neurovascular status. No patient in either group had a major loss of reduction. There was no significant difference between the rates of mild loss of reduction, which occurred in six of the twenty-eight patients treated with lateral entry and one of the twenty-four treated with medial and lateral entry (p = 0.107). There were no cases of iatrogenic ulnar nerve injury in either group. There were also no significant differences (p > 0.05) between groups with respect to the Baumann angle, change in the Baumann angle, humerocapitellar angle, change in the humerocapitellar angle, Flynn grade, carrying angle, elbow flexion, elbow extension, total elbow range of motion, return to function, or complications.

CONCLUSIONS: With use of the specific techniques employed in this study, both lateral entry pin fixation and medial and lateral entry pin fixation are effective in the treatment of completely displaced (type-III) extension supracondylar fractures of the humerus in children.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION: "Lateral Entry Compared with Medial and Lateral Entry Pin Fixation for Completely Displaced Supracondylar Humeral Fractures in Children. A Randomized Clinical Trial" (2007;89:706-12).

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    References

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Mininder S. Kocher, M.D., MPH
    Posted on April 11, 2008
    Clarification of Figure 7
    Children's Hospital, Boston, MA

    The drawing is correct and the caption is incorrect. We appreciate Dr. Naraen’s observation that Baumann described this angle as the long axis of the humerus and the inclination of capitellar physis. This can be also termed the “shaft-physeal” angle. There have been some reports of Baumann’s angle as the angle formed by the line perpendicular to the humeral shaft and parallel to the lateral condyle, but this should technically be termed as the complement of Baumann’s angle. We thank Dr. Naraen for clarifying this.

    Asheem Naraen
    Posted on April 08, 2008
    Definition of Baumann's Angle
    Department of Orthopaedics & Trauma, Harrogate Fdn & District Hospital NHS Trust, UK

    To The Editor:

    With reference to the very well written and useful article "Lateral Entry Compared To Medial And Lateral Entry For Completely Displaced Supracondylar Fractures In Children"(1) may I ask the authors why they have designated Baumann's angle as the angle between the longitudinal axis of humerus and a line parallel to the growth plate of the lateral condyle, and yet have described in the caption as the angle formed by the line perpendicular to the humeral shaft and the line parallel to the lateral condyle in Figure 7(2)?

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

    References:

    1. Yen YM, Kocher MS. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. Surgical Technique. J Bone Joint Surg Am. 2008;90A(Suppl 2) Part 1:20-30.

    2. Yen YM, Kocher MS. Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. Surgical Technique. J Bone Joint Surg Am. 2008;90A(Suppl 2) Part 1. Fig. 7, page 29.

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