Safe Cross-Pinning of Pediatric Supracondylar Humerus Fractures With a Flexion-Extension–External Rotation Technique

The issue of pin configuration for fixation of displaced supracondylar humerus fractures continues to be controversial.

In this article, we report on a large single-surgeon 12-year series in which a flexion-extension–external rotation technique of cross-pinning was used. We retrospectively reviewed all pediatric extension-type supracondylar humerus fractures treated by a single surgeon. The cases of 214 children (mean age, 5.8 years) and 215 medial-entry pins were reviewed in the final analysis. Surgical technique involved a classic hyperflexion maneuver and placement of lateral-entry pins. Indications for medial-entry pins included instability to intraoperative torsional stress examination or medial column comminution. The elbow was then extended to no more than 60° of flexion. The glenohumeral joint was externally
rotated to position the medial epicondyle directly en face to the radiographic beam before placement of a medial-entry Kirschner wire.

All reviewed patients had medial-entry pin placement with a flexion-extension–external rotation technique. Mean follow-up was 13 weeks. No ulnar nerve neurapraxias were reported.

Consistent protection of the ulnar nerve during percutaneous placement of a medial epicondylar pin for supracondylar humerus fracture can be accomplished
with partial elbow extension and glenohumeral external rotation after placement of lateral-entry pins.