A Foead, R Penafort, A Saw, S Sengupta
Department of Orthopaedic Surgery, University Malaya Medical Center, Kuala Lumpur, Malaysia

PURPOSE. To conduct a prospective randomised controlled study to compare the stability and risk of nerve injury between fractures treated by medial-lateral pin fixation and those treated by 2-lateral pin fixation.
Methods. Patients with displaced supracondylar fractures admitted between May 2000 and December 2001 were recruited into the study. They were randomised to treatment either with medial-lateral pin fixation (n=34) or with 2-lateral pin fixation (n=32).

RESULTS. 66 children with the mean age of 5.78 years were admitted during the study period. 11 of them were lost to follow-up. The mean follow-up period of the remaining 55 patients was 8.93 months. The difference in the carrying angle between injured and normal elbows was 3.57° and 3.70° in medial-lateral pin fixation and 2-lateral pin fixation, respectively. The extension and flexion loss was 7.14° and 8.68° respectively in medial-lateral pin fixation, and 7.11° and 11.26° respectively in 2-lateral pin fixation. The Baumann angle difference was 5.96° in medial-lateral pin fixation, and 5.30° in 2-lateral pin fixation. The difference in the medial epicondylar epiphyseal angle was 6.07° in medial-lateral pin fixation and 6.92° in 2-lateral pin fixation. Statistical analyses show that these differences are not significant. Five iatrogenic ulnar nerve injuries developed in the group treated by medial-lateral pin fixation, while 2 ulnar nerve and one radial nerve injuries were seen after 2-lateral pin fixation. Again the differences were not statistically significant.

CONCLUSION. Both methods of fixation were comparable in terms of stability, duration of bone healing, and risks of injury to the nerve.