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/)
___
Otsuka NY, Kasser JR. Supracondylar fractures of the humerus in children. J Am Acad Orthop Surg. 1997;5:19e26.
Shrader MW. Pediatric supracondylar fractures and pediatric phaseal elbow fractures. Orthop Clin North Am. 2008;39:163e171.
Gartland JJ. Management of supracondylar fractures of the humerus in children. Surg Gynecol Obstet. 1959;109:145e154.
Abzug JM, Herman MJ. Management of supracondylar humerus fractures in children: current concepts. J Am Acad Orthop Surg. 2012;20:69e77.
Aksakal M, Ermutlu C, Sarisozen B, Akesen B. Approach to supracondylar hu- merus fractures with neurovascular compromise in children. Acta Orthop Traumatol Turc. 2013;39(4):244e249.
Omid R, Choi PD, Skaggs DL. Supracondylar humeral fractures in children. J Bone Jt Surg Am. 2008;90:1121e1132.
Kocher MS, Kasser JR, Waters PM, et al. Lateral entry compared with medial and lateral entry pinŞxation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial. J Bone Jt Surg Am. 2007;89(4): e712.
Gaston RG, Cates TB, Devito D, et al. Medial and lateral pin versus lateraldentry pinŞxation for Type 3 supracondylar fractures in children: a prospective, surgeon randomized study. J Pediatr Orthop. 2010;30(8):799e806.
Zhao JG, Wang J, Zhank P. Is lateral pinŞxation for displaced supracondylar fractures of the humerus better than crossed pins in children? Clin Orthop Relat Res. 2013;471(9):2942e2953.
Oztürkmen Y, Karamehmetoglu M, Azboy I. Closed reduction and percutaneous lateral pin Şxation in the treatment of displaced supracondylar fractures of the humerus in children. Acta Orthop Traumatol Turc. 2005;39(5):396e403.
Larson L, Firoozbakhsh K, Passarelli R, Bosch P. Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures. J Pediatr Orthop. 2006;26(5), 573e8.
Skaggs DL, Hale JM, Bassett J, et al. Operative treatment of supracondylar fractures of the humerus in children. The consequences of pin placement. J Bone Jt Surg Am. 2001;83-A:735e740.
Zionts LE, McKellop HA, Hathaway R. Torsional strength of pin conŞgurations used toŞx supracondylar fractures of the humerus in children. J Bone Jt Surg Am. 1994;76:253e256.
Skaggs DL, Cluck MW, MostoŞ A, et al. Lateraleentry pin Şxation in the management of supracondylar fractures in children. J Bone Jt Surg Am. 2004;86: e707.
Lyons JP, Ashley E, Hoffer MM. Ulnar nerve palsies after percutaneous cross- epinning of supracondylar fractures in children's elbows. J Pediatr Orthop. ;18:43e45. Ozcelik A, Tekcan A, EUROmeroglu H. Correlation between iatrogenic ulnar nerve injury and angular insertion of the medial pin in supracondylar humerus fractures. J Pediatr Orthop B. 2006;15:58e61.
Keenan WN, Clegg J. Variation of Baumann's angle with age, sex, side: impli- cations for its use in radiological monitoring of supracondylar fracture of the humerus in children. J Pediatr Orthop. 1996;16:97e98.
Pennoc AT, Charles M, Moor M, Bastrom TP, Newton PO. Potential causes of loss of reduction in supracondylar humerus fractures. J Pediatr Orthop. 2014;34(7): e697.
Flynn JC, Matthews JG, Benoit RL. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen years' experience with long- dterm followdup. J Bone Jt Surg Am. 1974;56:263e272.
Aarons CE, Lobts C, Chan DB, Landy DC. Repair of supracondylar humerus fractures in children: does pin spread matter? J Pediatr Orthop B. 2012;21(6): e504.
Sankar WN, Hebela NM, Skaggs DL, Flynn JM. Loss of pinŞxation in displaced supracondylar humeral fractures in children: causes and prevention. J Bone Jt Surg Am. 2007;89(4):713e717.