Results of crossed versus lateral entry K-wire fixation of displaced pediatric supracondylar humeral fractures: A systematic review and meta-analysis

PurposeSupracondylar humeral fractures (SCHF) are among the most common injuries in children. The aim of this systematic review was to investigate functional and radiographic outcome after crossed and lateral K-wire fixation for displaced extension-type SCHF, and complications related to the type of K-wire construction used.MethodsRCTs and prospective comparative cohorts on the functional outcome and complications after fracture reduction and K-wire fixation were identified in MEDLINE, Embase, Web of Science and the Cochrane Library.ResultsThirteen studies were identified, including 1158 patients in seven RCTs and six prospective comparative cohorts. According to the Flynn criteria, there was no difference in outcome between the K-wire configurations (Relative Risk 1.07). Loss of reduction occurred in 27 (11.6%) of 232 patients treated with crossed K-wires, and in 35 (12.4%) of 282 patients treated with lateral entry K-wires. Twenty (4.1%) of 493 patients in the crossed group were diagnosed with iatrogenic ulnar nerve injury, compared with 2 (0.3%) of 666 patients in the lateral entry group. The overall incidence of persistent ulnar nerve related complaints was 3.5/1000.ConclusionsCrossed and lateral entry pin fixation of SCHF result in similar construct stability and functional outcome. Although ulnar nerve injury was three times more likely in the crossed K-wire group, the overall incidence of this complication was very low. The available evidence does not support the use of either approach for daily practice. If the surgeon wishes to avoid all potential risk of iatrogenic ulnar nerve injury, the lateral K-wire approach is safest.