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A meta-analysis of randomized controlled trials compared lateral-only with cross-pinning for pediatric supracondylar humerus fractures. Across 11 randomized trials involving 900 patients, cross-pinning provided somewhat better resistance to loss of reduction, while lateral pinning substantially reduced the risk of iatrogenic ulnar nerve injury. There was no clear difference in several other radiographic and infection outcomes. Clinically, this is a classic trade-off between mechanical stability and neurological safety. The evidence suggests that a lateral construct is often preferable when it can achieve adequate stability, particularly when the risk of medial pin-related nerve injury is a concern. Cross-pinning remains an important technique for fractures in which lateral pins do not provide sufficient stability. For HCPs, the key message is that pin configuration should be tailored to fracture geometry and the surgeon should know how to mitigate the specific risks of the chosen approach. Careful imaging, stable reduction and appropriate pin placement are more important than rigid adherence to one universal construct.
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A meta-analysis of randomized controlled trials compared lateral-only with cross-pinning for pediatric supracondylar humerus fractures. Across 11 randomized trials involving 900 patients, cross-pinning provided somewhat better resistance to loss of reduction, while lateral pinning substantially reduced the risk of iatrogenic ulnar nerve injury. There was no clear difference in several other radiographic and infection outcomes. Clinically, this is a classic trade-off between mechanical stability and neurological safety. The evidence suggests that a lateral construct is often preferable when it can achieve adequate stability, particularly when the risk of medial pin-related nerve injury is a concern. Cross-pinning remains an important technique for fractures in which lateral pins do not provide sufficient stability. For HCPs, the key message is that pin configuration should be tailored to fracture geometry and the surgeon should know how to mitigate the specific risks of the chosen approach. Careful imaging, stable reduction and appropriate pin placement are more important than rigid adherence to one universal construct.
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