Modified Dorgan‘s technique for pinning supracondylar humeral fracture percutaneously

Abstract

Introduction Fractures of the bones, involved in elbow joint, especially distal humerus, are diagnosed commonly in children. They compose to 10 % of all paediatric fractures. Distal supracondylar humeral fractures (DSCHF) (type IIB and type III according to Wilkins-Gartland classification) are treated by closed reduction and percutaneous pinning with K-wires (PPKW) (cross pinning) - K-wires are crossed through both humeral condyles. However, this surgical technique often results iatrogenic injuries of ulnar nerve. Also, other percutaneous pinning methods are used - 2, 3 or 4 K-wires may be spiked through lateral humeral condyle only, but such kind of fixation reduce biomechanical stability of fragments even to 58 %. We suggest to apply the modification of Dorgan technique (cross-lateral pinning) – primarily a K wire is introduced through lateral condyle, then the second K-wire is introduced through medial condyle. Aims and Objectives To optimize the tactics of the treatment in children with displaced supracondylar humeral fracture (DSCHF). To evaluate incidence of iatrogenic ulnar nerve injury using modified Dorgan technique. Materials and methods From 2012-01-01 to 2021-12-31 75 patients, which included all inclusion criteria were treated at Orthopaedics Surgery division of Clinic of Paediatrics Surgery using modified Dorgan technique (cross-lateral pinning) – primarily a K-wire is introduced through lateral condyle, then the second K-wire is introduced through medial condyle. This technique of cross pinning of K-wire enables easy-to-perform traditional PPKW (cross pinning) technique to be easily converted to the safest Dorgan technique. We suggest to name it modified Dorgan technique or Kaunas technique. Results Using modified Dorgan technique for children with DSCHF provides stable fixation and no iatrogenic neurological complications were detected. Conclusions After evaluation of study results and publications’ analysis we suppose that our recommended modified Dorgan technique of percutaneous pinning for the treatment of the children with distal supracondylar humeral fracture is not more complicated technically than traditional PPKW (cross pinning), but safety of it do not yield to Dorgan technique (lateral-cross), biomechanical stability of fragments is not reduced. We expect, that applying of this technique (modified Dorgan technique – cross-lateral pinning) in daily practice of paediatric orthopaedic surgeon will lead to significant reduction of complete prevention of iatrogenic complications of ulnar nerve.