Abstract / Summary
Abstract Background Closed reduction and percutaneous pinning is standard treatment for displaced pediatric supracondylar humeral fractures, but the optimal pin configuration remains debated. We compared clinical and radiographic outcomes between lateral two-pin and medial-pin–augmented (crossed) fixation, focusing on the medial epicondylar epiphyseal angle (MEEA) as a comparative outcome rarely used for this purpose. Methods We retrospectively analyzed 202 children aged 2 to 12 years with Gartland type II to III supracondylar humeral fractures treated surgically between 2016 and 2021. Group 1 (117 children) received two divergent lateral wires plus one medial wire via mini-open incision; Group 2 (85 children) received two lateral wires only. The decision to add a medial wire reflected a mix of surgeon routine and intraoperative judgment of construct stability, not a fixed protocol. Outcomes were the Flynn rating, loss of carrying angle and elbow motion, and the Baumann, humeroulnar, medial epicondylar epiphyseal, and diaphysiometaphyseal angles, measured at final follow-up against the uninjured side. The Benjamini–Hochberg procedure controlled for multiple comparisons. Results Mean follow-up was 28.4 months; groups were comparable at baseline. Operative time was longer in Group 1 (40.7 versus 24.2 minutes; p < 0.001). Group 1 showed less loss of elbow motion (p = 0.008) and higher humeroulnar (p = 0.010) and medial epicondylar epiphyseal angles (p < 0.001) — the largest difference measured, remaining significant after correction; loss of carrying angle was also lower (p = 0.047) but not significant after correction. The Baumann angle and Flynn rating did not differ. No iatrogenic ulnar nerve injury occurred. Conclusions Medial-pin augmentation was associated with better-preserved alignment and motion at final follow-up. MEEA may detect medial-column alignment differences not captured by the Baumann angle, making it the more sensitive comparative measure here, without increased nerve injury. Because allocation was non-randomized, these findings describe an association rather than proof of superior fixation strength, and support selective rather than routine use of the added medial wire. Trial registration: Not applicable. This is a retrospective observational cohort study of a previously performed surgical treatment, not a prospectively registered clinical trial.