Outcomes in the management of Gartland III supracondylar fracture in a paediatric institution

Abstract

Background: Supracondylar fractures are the most common elbow fracture described in children. Different types of fixation, including cross- and side-pin fixations, have been described and compared. However, there is still controversy about which of the two techniques provides better stability and results. The iatrogenic injury of the ulnar nerve is a known complication of the medial pin compared to the side pins placement.
Materials and methods: An evaluation was made of a retrospective cohort of patients diagnosed with Gartland III supracondylar fractures. The aim was to compare post-operative neurological injuries in patients treated with cross pin vs. side pins.
Results: A total of 141 patients were included, of whom 61% were boys. Closed reduction was performed in 96.5% of the cases, and crossed nail fixation was used in 78.7% of them. The post-operative diagnosis classification changed from Gartland III to IV in 18.4% of the cases. Post-operative nerve injury was present in 12.8% of patients, with the ulnar nerve being the most affected (61.1%). There were no statistically significant differences between the groups
with and without neurological injury.
Discussion: The incidence of iatrogenic ulnar nerve injuries after crossed pins fixation has been reported in the literature to be as high as 15%, which was similar to the one found in our study (12.8%). Elbow flexion -necessary to maintain the fracture reduction, as well as elbow oedema are known factors for the injury of the ulnar nerve. The injury of the ulnar nerve should be avoided at all costs during the osteosynthesis with crossed pins. Therefore, the technique described by Dorgan is recommended, which uses a minimal medial incision and exploration of the ulnar nerve before the osteosynthesis with nails is performed.
Evidence level: III.