{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:30:36Z","timestamp":1786354236823,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Closed reduction and percutaneous pinning is the standard surgical treatment for displaced pediatric supracondylar humerus fractures. Although crossed-pin fixation provides excellent biomechanical stability, medial pin insertion remains associated with the risk of iatrogenic ulnar nerve injury. The modified medial para-olecranon technique has been introduced as an alternative medial wire insertion strategy while preserving the principles of crossed-pin fixation. This study compared its clinical performance with conventional crossed pinning. Methods: A retrospective comparative cohort study was conducted at a tertiary referral trauma center between January 2017 and December 2024. Seventy children younger than 14 years with Gartland type II\u2013IV supracondylar humerus fractures met the inclusion criteria. All patients treated with the modified medial para-olecranon technique (n = 35) were included. A comparison cohort of 35 patients treated with conventional crossed pinning was selected from 68 eligible conventionally treated patients by computer-generated random sampling stratified by Gartland type (frequency matching), after application of identical eligibility criteria. The primary outcome was functional outcome assessed using the Flynn criteria. Secondary outcomes included operative time, radiographic alignment, fracture union, and postoperative complications. Results: Baseline demographic and fracture characteristics were comparable between groups. Mean age was 6.7 \u00b1 2.8 years in the modified medial para-olecranon group and 6.9 \u00b1 2.6 years in the conventional crossed-pin group. The modified medial para-olecranon group had a lower mean Flynn score (6.80 \u00b1 3.31 vs. 10.74 \u00b1 3.70; mean difference, \u22123.94; 95% CI, \u22125.61 to \u22122.27; p &lt; 0.001) and a higher proportion of excellent Flynn outcomes (77.1% vs. 28.6%). Operative time was shorter in the modified medial para-olecranon group (47.49 \u00b1 7.50 vs. 66.00 \u00b1 8.19 min; mean difference, \u221218.51 min; 95% CI, \u221222.26 to \u221214.76; p &lt; 0.001). Fracture union occurred at a comparable time in both groups (27.71 \u00b1 3.94 vs. 28.34 \u00b1 4.12 days; mean difference, \u22120.63 days; 95% CI, \u22122.55 to 1.29), and postoperative Baumann angles were similar. No postoperative iatrogenic ulnar nerve injuries occurred in the modified medial para-olecranon group, whereas two occurred in the conventional crossed-pin group; both were transient sensory paraesthesia that resolved without exploration within six months. Overall complications occurred in 1 patient (2.9%) and 7 patients (20.0%), respectively (odds ratio, 0.17; 95% CI, 0.03 to 1.02; Fisher exact p = 0.055). Conclusions: In this retrospective comparative cohort, the modified medial para-olecranon technique was associated with favorable functional outcomes, shorter operative time, and fewer observed postoperative ulnar nerve injuries, although the difference in complications did not reach statistical significance, while maintaining comparable radiographic alignment and fracture healing. Because treatment was not randomized and potential confounders could not be adjusted for, these between-group differences should be interpreted as associations rather than as evidence of a causal treatment effect. Further prospective multicenter studies and dedicated anatomical investigations are required before broader recommendations can be made.<\/jats:p>","DOI":"10.3390\/children13081063","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:08:53Z","timestamp":1786349333000},"page":"1063","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Modified Medial Para-Olecranon Pinning Versus Conventional Crossed Pinning for Displaced Pediatric Supracondylar Humerus Fractures: A Retrospective Comparative Cohort Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3529-3408","authenticated-orcid":false,"given":"Hassan Salah","family":"Ibrahim","sequence":"first","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Rashid Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulla","family":"Abdelwahab","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Rashid Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girgis","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Rashid Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8481-9002","authenticated-orcid":false,"given":"Habib Al","family":"Ismaily","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Trauma Surgery, Rashid Hospital, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai 505055, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5435\/00124635-199701000-00003","article-title":"Supracondylar fractures of the humerus in children","volume":"5","author":"Otsuka","year":"1997","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1097\/01241398-199801000-00008","article-title":"Etiology of supracondylar humerus fractures","volume":"18","author":"Farnsworth","year":"1998","journal-title":"J. Pediatr. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/00005131-199302000-00004","article-title":"Limb fracture pattern in different pediatric age groups: A study of 3,350 children","volume":"7","author":"Cheng","year":"1993","journal-title":"J. Orthop. Trauma"},{"key":"ref_4","first-page":"145","article-title":"Management of supracondylar fractures of the humerus in children","volume":"109","author":"Gartland","year":"1959","journal-title":"Surg. Gynecol. Obstet."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/S0030-5898(20)31545-5","article-title":"The operative management of supracondylar fractures","volume":"21","author":"Wilkins","year":"1990","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_6","unstructured":"American Academy of Orthopaedic Surgeons (2011). The Treatment of Pediatric Supracondylar Humerus Fractures: Clinical Practice Guideline, American Academy of Orthopaedic Surgeons."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"706","DOI":"10.2106\/00004623-200704000-00002","article-title":"Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children","volume":"89","author":"Kocher","year":"2007","journal-title":"J. Bone Jt. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"253","DOI":"10.2106\/00004623-199402000-00013","article-title":"Torsional strength of pin configurations used to fix supracondylar fractures of the humerus in children","volume":"76","author":"Zionts","year":"1994","journal-title":"J. Bone Jt. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/01241398-200207000-00005","article-title":"Displaced pediatric supracondylar humerus fractures: Biomechanical analysis of percutaneous pinning techniques","volume":"22","author":"Lee","year":"2002","journal-title":"J. Pediatr. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/01.bpo.0000230336.26652.1c","article-title":"Biomechanical analysis of pinning techniques for pediatric supracondylar humerus fractures","volume":"26","author":"Larson","year":"2006","journal-title":"J. Pediatr. Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1097\/bpo.0b013e3180316cf1","article-title":"A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus","volume":"27","author":"Brauer","year":"2007","journal-title":"J. Pediatr. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/BOT.0b013e3182143de0","article-title":"Meta-analysis of pinning in supracondylar fracture of the humerus in children","volume":"26","author":"Woratanarat","year":"2012","journal-title":"J. Orthop. Trauma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2942","DOI":"10.1007\/s11999-013-3025-4","article-title":"Is lateral pin fixation for displaced supracondylar fractures of the humerus better than crossed pins in children?","volume":"471","author":"Zhao","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1186\/s13018-018-0768-3","article-title":"Comparison of lateral entry with crossed entry pinning for pediatric supracondylar humeral fractures: A meta-analysis","volume":"13","author":"Na","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/01241398-199801000-00009","article-title":"Ulnar nerve palsies after percutaneous cross-pinning of supracondylar fractures in children","volume":"18","author":"Lyons","year":"1998","journal-title":"J. Pediatr. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/01241398-199507000-00005","article-title":"Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children","volume":"15","author":"Brown","year":"1995","journal-title":"J. Pediatr. Orthop."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1097\/BPO.0b013e3181b768ac","article-title":"Complications after pinning of supracondylar distal humerus fractures","volume":"29","author":"Bashyal","year":"2009","journal-title":"J. Pediatr. Orthop."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/BPB.0b013e328010b684","article-title":"Prevention of ulnar nerve injury during fixation of supracondylar fractures in children by flexion-extension cross-pinning","volume":"16","author":"Eidelman","year":"2007","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"94","DOI":"10.11622\/smedj.2017094","article-title":"Paediatric supracondylar humeral fractures: A technique for safe medial pin passage with zero incidence of iatrogenic ulnar nerve injury","volume":"59","author":"Woo","year":"2018","journal-title":"Singap. Med. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1097\/BPO.0b013e318263a3c0","article-title":"Ultrasound evaluation of ulnar nerve anatomy in the pediatric population","volume":"32","author":"Erez","year":"2012","journal-title":"J. Pediatr. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1097\/01241398-200207000-00006","article-title":"Predicting ulnar nerve location in pinning of supracondylar humerus fractures","volume":"22","author":"Wind","year":"2002","journal-title":"J. Pediatr. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"702","DOI":"10.2106\/00004623-200404000-00006","article-title":"Lateral-entry pin fixation in the management of supracondylar fractures in children","volume":"86","author":"Skaggs","year":"2004","journal-title":"J. Bone Jt. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/01241398-199507000-00004","article-title":"Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures","volume":"15","author":"Topping","year":"1995","journal-title":"J. Pediatr. Orthop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1177\/230949900401200114","article-title":"Comparison of two methods of percutaneous pin fixation in displaced supracondylar fractures of the humerus in children","volume":"12","author":"Foead","year":"2004","journal-title":"J. Orthop. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1097\/BPO.0b013e3181f73d59","article-title":"Medial and lateral pin versus lateral-entry pin fixation for type 3 supracondylar fractures in children: A prospective, surgeon-randomized study","volume":"30","author":"Gaston","year":"2010","journal-title":"J. Pediatr. Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"S143","DOI":"10.1097\/BPO.0b013e318255b17b","article-title":"The treatment of displaced supracondylar humerus fractures: Evidence-based guideline","volume":"32","author":"Mulpuri","year":"2012","journal-title":"J. Pediatr. Orthop."},{"key":"ref_27","first-page":"CD013506","article-title":"Interventions for treating supracondylar elbow fractures in children","volume":"6","author":"Marson","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2106\/00004623-197456020-00004","article-title":"Blind pinning of displaced supracondylar fractures of the humerus in children: Sixteen years\u2019 experience with long-term follow-up","volume":"56","author":"Flynn","year":"1974","journal-title":"J. Bone Jt. Surg."},{"key":"ref_29","first-page":"644","article-title":"What is the best fixation technique for the treatment of supracondylar humerus fractures in children?","volume":"52","author":"Patriota","year":"2017","journal-title":"Rev. Bras. Ortop."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.aott.2016.11.003","article-title":"Is pin configuration the only factor causing loss of reduction in the management of pediatric type III supracondylar fractures?","volume":"51","author":"Reisoglu","year":"2017","journal-title":"Acta Orthop. Traumatol. Turc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"245","DOI":"10.52628\/88.2.9691","article-title":"Pediatric distal humeral supracondylar fracture: Achievement of optimal pinning configuration","volume":"88","author":"Chong","year":"2022","journal-title":"Acta Orthop. Belg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.injury.2019.03.042","article-title":"Pinning of supracondylar fractures in children: Strategies to avoid complications","volume":"50","author":"Rupp","year":"2019","journal-title":"Injury"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13018-023-03528-8","article-title":"Medial\u2013lateral versus lateral-only pinning fixation in children with displaced supracondylar humeral fractures: A meta-analysis of randomized controlled trials","volume":"18","author":"Xing","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.jse.2021.12.048","article-title":"Analysis of the location and trajectory of Kirschner wires in the fixation of extension-type supracondylar fracture of the humerus by 3D computational simulation","volume":"31","author":"Wang","year":"2022","journal-title":"J. Shoulder Elb. Surg."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1063\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T08:46:21Z","timestamp":1786351581000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["children13081063"],"URL":"https:\/\/doi.org\/10.3390\/children13081063","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]}}}