| Abstract: |
Management of pediatric supracondylar humerus fractures remains a clinical challenge, primarily due to the risk of iatrogenic ulnar nerve injury during medial pinning and vascular compromise associated with traditional hyperflexion casting. This study evaluates a decade-long experience using a specific protocol: closed reduction internal fixation via Dorgan’s lateral cross-pinning combined with post-operative immobilization in a 150° extension position. The primary objective was to assess long-term stability, neurovascular safety, and functional recovery. A longitudinal retrospective cohort study was conducted over a ten-year period (2015–2024), involving 112 pediatric patients (ages 2–15 years). The cohort included 75 Gartland Type II and 37 Gartland Type III fractures. All patients underwent percutaneous fixation using two 1.6mm K-wires introduced solely through a lateral entry point to engage both columns. Post-operative immobilization was maintained in a long-arm cast at 150° of extension for three weeks. Clinical and radiographic outcomes were analyzed using Flynn’s criteria and Baumann’s angle measurements. The mean follow-up duration was 5 years. There were zero cases (0%) of iatrogenic ulnar nerve palsy or postoperative vascular insufficiency. Radiographic analysis confirmed stable maintenance of reduction, with a mean Baumann’s angle of 72.4°. Functional outcomes were categorized as "Excellent" in 96.4% of cases and "Good" in 3.6%. Complications were minimal, consisting of 7 cases of superficial pin-site infections and 9 cases of minor plaster slippage, none of which affected final joint alignment or range of motion. A ten-year evaluation demonstrates that lateral cross-pinning combined with 150° extension casting is a robust and safe alternative to conventional methods. By eliminating medial-side pinning, the risk of nerve damage is neutralized, while the extension casting position provides a "vascular safety zone" that ensures optimal limb perfusion without sacrificing fracture stability or anatomical alignment. |
