RADIOLOGICAL COMPARISON OF LATERAL ENTRY COMPARED WITH COMBINED MEDIAL AND LATERAL ENTRY PIN FIXATION FOR TYPE III SUPRACONDYLAR FRACTURES IN CHILDREN WITH PARTICULAR FOCUS ON ROTATIONAL DISPLACEMENT

Introduction Both cross and lateral pinning are common techniques used for displaced supracondylar elbow fractures in children. Our study aims to determine whether there are any radiological differences in outcome between the two techniques. Most recent studies involving radiological evaluation of supracondylar fractures had concentrated on use of Bauman9s angle or humerocapitellar angles. Rotational displacement, which has been shown to be critical for stability, is often not adequately addressed. Our evaluation measures both linear displacement using Bauman9s angle and rotational displacement through the measurement of the lateral rotational percentage (LRP). Method We retrospectively reviewed the radiographs of all type III supracondylar fractures reduced with either crossed pins (one medial and one lateral, one medial and two lateral) or lateral pins (two or three lateral) between 2002 and 2006 at the Royal Children9s Hospital. A good quality AP and lateral radiograph taken preoperatively, immediately postoperatively, and at the first follow up session was required for patients to be included in the study. Those that had LRP change of greater than 10% were further investigated. Results 66 of the 184 patients identified with type III supracondylar fracture with k wire fixation had adequate radiographs for the study. Thirty-three in the lateral pinning group and 33 in the cross pinning group. Results using Mann-Whitely test show nil significant differenced between the crossed and lateral pinned groups in terms of both Bauman9s (p value 0.5767) angle and Lateral Rotational Profile (p value 0.063). Those that had LRP change were further investigated. The results showed that there was no difference between the cross pinning and lateral pinning in carrying angle or range of motion by the time of their last follow up. Conclusion There is no significant difference in terms of the rate of loss of reduction radiologically using either the lateral pinning or crossed pinning method for treatment of type III supracondylar fractures in children.