Kocher supracondylar pinning RCT

Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children. A randomized clinical trial.

Kocher MS, Kasser JR, Waters PM, et al. The Journal of bone and joint surgery. American volume 2007 · PMID 17403790 · doi:10.2106/jbjs.f.00379

Question

Does lateral-entry pinning give equivalent stability to crossed medial and lateral pinning for displaced paediatric supracondylar fractures?

Design

Single-centre randomised controlled trial at a US children's hospital.

Patients

Children with completely displaced (Gartland type III) extension supracondylar humeral fractures.

Intervention

Closed reduction and lateral-entry K-wire fixation

Comparison

Closed reduction and crossed medial and lateral K-wire fixation

Primary outcome

Major loss of reduction and iatrogenic ulnar nerve injury

Key result

Neither group had a major loss of reduction or an iatrogenic ulnar nerve injury; mild loss of reduction, radiographic angles, alignment and elbow motion did not differ significantly between lateral-entry and crossed pinning.

Limitations

Small single-centre trial performed by experienced paediatric surgeons; underpowered for the rare outcome of iatrogenic ulnar nerve injury.

Impact on practice

Supports lateral-entry pinning with good wire spread as a safe default that avoids the risk of iatrogenic ulnar nerve injury from a medial wire, as reflected in BOAST guidance.