Comparison of radiological and clinical results between posterior and cross-pinning and cross-pinning alone in gartland stage II-III pediatric supracondylar humerus fractures - a prospective randomized controlled trial

Objective: The treatment of pediatric humerus supracondylar fractures using crossed Kirschner wire fixation, either closed or open, is a common and recommended method. However, the optimal K-wire configuration remains controversial. We aim in this study is to compare the radiological and clinical outcomes of posterior intrafocal K-wire + crossed pinning with the crossed pinning method alone in the treatment of extension-type Gartland stage II-III pediatric supracondylar humerus fractures. Materials and Methods: A total of 52 pediatric patients aged between 2-18 years, diagnosed with extension-type Gartland stage II-III supracondylar humerus fractures, who presented to our hospital's emergency department and outpatient clinic between May 2023 and May 2024, were included in the study. Patients were randomly assigned to either the study group or control group using a closed-envelope method. Prior to surgery, a patient card was created for each patient, recording demographic information. Patients were called for outpatient follow-up at weeks 3, 5, and 8 postoperatively. During each follow-up, routine anteroposterior (AP) and lateral radiographs were taken. Clinically, range of motion (ROM) of the elbow joint, Flynn criteria, and radiological assessments including Bauman angle, lateral humerocapitellar angle, RUS score, and percentage of lateral rotation were measured. Results: The average age and gender distribution of the posterior + crossed pin and crossed pin groups were similar. No significant loss of reduction was observed in either group. None of the patients experienced iatrogenic ulnar nerve injury. Clinically, at the 3-week follow-up, ROM angles were significantly higher in the study group compared to the control group (p=0,022). There was no significant difference between the groups in terms of return to function according to Flynn criteria. Radiologically, the Bauman angles were significantly higher in the study group compared to the control group (p=0,022). The RUS score was significantly higher in the control group compared to the study group (p=0,044). No significant differences were observed between the groups in terms of changes in the humerocapitellar angle or complications. Conclusion: Pediatric supracondylar humerus fractures are one of the most challenging and demanding issues in orthopedics. There is a significant positive correlation between postoperative radiological alignment and functional outcomes. The results of cross + posterior pinning and isolated cross pinning are similar. The surgeon should aim to achieve reduction using the method they are most comfortable with and experienced in.