Proximal lateral entry technique for the treatment of supracondylar humeral fractures in children and intraoperative nerve protection: a novel technique.

Abstract

Background: To evaluate the clinical outcomes of the proximal lateral-entry pinning technique in the treatment of supracondylar humeral fractures and to explore its performance in terms of intraoperative nerve protection.

Methods: This retrospective analysis involved data from pediatric patients with supracondylar humeral fractures who were admitted to the Department of Pediatric Surgery at Binzhou Medical University Hospital between September 2017 and November 2023. A total of 342 patients were included and divided into two groups: Group P (proximal lateral-entry pinning) and Group C (conventional lateral condyle pinning). All patients were followed up for at least 6 months postoperatively. Baseline characteristics, the interval from injury to surgery, the operative time, the fracture healing status, and the timing of Kirschner wire removal were recorded. Elbow function was assessed using Flynn's functional and cosmetic criteria. Statistical comparisons were conducted using the Mann-Whitney U test, independent samples t-test, chi-square test, or Fisher's exact test, as appropriate. Complications such as loss of reduction, elbow deformity, vascular injury, iatrogenic nerve injury, and pin-tract infection were also documented.

Results: There were no statistically significant differences in sex, body weight, age at injury, fracture laterality, anesthesia type, or waiting time from injury to surgery between the two groups (P > 0.05). Additionally, the operative time and timing of Kirschner wire removal did not differ significantly between the groups (P > 0.05). At the final follow-up, the proportion of patients with excellent/good elbow function in Group P was 99.42%, which was significantly greater than the proportion of 94.64% observed in Group C (P < 0.05). No radial or ulnar nerve injuries were reported in either group. Three cases of pin-tract infection occurred in Group P, and seven cases occurred in Group C (P > 0.05). Loss of reduction occurred in three cases in Group P and11 in Group C (P > 0.05). No incidences of elbow deformity or iatrogenic vascular injury were noted.

Conclusion: The proximal lateral-entry pinning technique yields favorable fracture outcomes and does not increase the risk of radial or ulnar nerve injury when it is performed meticulously. This approach is therefore recommended as a viable surgical technique for treating supracondylar humeral fractures in children.