An observational study on radiological and functional outcome of cross pinning versus parallel pinning in supracondylar humerus fracture

Introduction Supracondylar humerus fractures are the most common elbow fractures in children, often resulting from falls on an outstretched hand. The standard treatment for displaced fractures involves closed reduction and percutaneous pinning. However, the optimal pin configuration — cross-pinning (medial‑lateral) versus parallel pinning (lateral-lateral) — remains a topic of debate due to concerns regarding stability and risk of iatrogenic ulnar nerve injury.
Aims This study aims to compare the clinical and radiological outcomes of cross-pinning versus parallel inning in the management of displaced supracondylar humerus fractures in children.
Methods A prospective observational study was conducted over 18 months at Kalpana Chawla Govt. Medical College, Karnal, Haryana. A total of 54 children aged 3–12 years with Gartland type III supracondylar humerus fractures were enrolled. Patients were divided into two groups based on the surgical technique: cross-pinning (n = 27) and parallel pinning (n = 27). Both groups were comparable in terms of demographics, mechanism of  injury, and pre-operative neurovascular status. Functional and radiographic outcomes were evaluated using Flynn’s criteria, Baumann’s angle, carrying angle, and range of motion at follow-up intervals (3, 6, 10, 14, and 24 weeks).
Results Mean Baumann’s angle, Carrying angle and range of motion showed no statistically significant differences between the two groups. At the final follow-up, 92.6 % of patients in the parallel pinning group had excellent outcomes per Flynn’s criteria, compared to 51.9 % in the cross-pinning group (p < 0.01). One patient in the cross-pinning group developed ulnar nerve neuropraxia, whereas no cases of nerve injury were reported in the parallel pinning group.
Conclusion Parallel pinning demonstrated superior radiological and functional outcomes, with a lower risk of ulnar nerve injury compared to cross pinning. These findings suggest that parallel pinning should be the preferred method for stabilizing displaced supracondylar humerus fractures in children.

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