Fracture stability after pinning of displaced supracondylar distal humerusfractures in children

Between January 1, 1994 and December 31, 1997, We evaluated 138 children wi th displaced supracondylar distal humerus fractures treated by closed reduc tion and percutaneous pinning. Then were 49 type II fractures and 89 type I n: fractures. Three principal pin configurations were used at the surgeon's discretion: 2 lateral pins (42 fractures), 1 medial and 1 lateral pin (37 fractures), and 1 medial and ? lateral pins (57 fractures). There was no st atistically significant difference in clinical stability between these grou ps. One type III fracture pinned using two lateral pins showed marked rotat ional instability. We recommend using two lateral pins when treating type I l fractures. Type LII fractures should be treated using two lateral pins in itially and, if the elbow demonstrates significant intraoperative rotationa l instability, a medial pin should be added. If a medial pin is necessary, and the ulnar nerve cannot be identified by palpation, a small incision sho uld be made and the pin placed under direct vision.