ArticleFrontiers in pediatrics2026
Non-rotational medial pinning with the K-Hammer technique in pediatric supracondylar fractures: a retrospective case-control study.
Article in Frontiers in pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pediatric Gartland type III-IV extension-type supracondylar humeral fractures are associated with a risk of iatrogenic ulnar nerve injury during medial percutaneous pin insertion. The optimal technique for medial pin placement during crossed pin fixation remains debated. Methods: A retrospective case-control study was conducted involving 80 pediatric patients treated between September 2020 and September 2025. All patients had isolated closed extension-type Gartland III-IV supracondylar humeral fractures treated with two lateral and one medial crossed K-wires, with a minimum follow-up of 6 months. Patients were divided into the K-Hammer group, in which medial pinning was performed using a non-rotational K-Hammer-assisted technique with the elbow in 30°-60° extension, and the Freehand group, in which medial pinning was performed using conventional low-speed drilling with the elbow flexed at 90°. The primary outcome was symptomatic iatrogenic ulnar nerve injury within 2 weeks postoperatively. Secondary outcomes included medial pin attempts, operative time, radiographic alignment, elbow range of motion, Flynn functional grade, and postoperative complications. Results: The K-Hammer group had significantly fewer medial pin attempts [1.0 (IQR: 1.0-1.0) vs. 2.0 (IQR: 1.0-2.0), Conclusions: The K-Hammer technique improves operative efficiency, reduces pin insertion attempts, and demonstrates a favorable trend toward reduction in iatrogenic ulnar nerve injury risk (ARR 11.9%, NNT = 8.4), without compromising radiographic or functional outcomes. Although statistical significance was not reached (
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