Lateral Entry Pinning of Supracondylar Humerus Fractures

Outstanding results in the use of lateral entry pins in the treatment of supracondylar fractures in children have been reported, and it continues to be our preferred technique. Clinical experience of a series of 124 consecutive supracondylar humerus fractures, including completely unstable fractures, has taught us that lateral pins, when properly placed, are strong enough to maintain reduction of even the most unstable supracondylar humerus fracture. The aim of lateral pin placement is to maximally separate the pins at the fracture site to engage both the medial and lateral columns. In accordance with standard fracture principles, pins that cross or are close together at the fracture site do not provide adequate stability. Similarly, if insufficient bone is engaged in either the proximal or the distal fragments, loss of fixation may be expected. After reduction and fixation, the fracture should be stressed under live imaging. If a medial pin must be used, the surgeon should take care to extend the elbow while inserting this pin.