technique (Figure – 2). A thorough pre-operative clinical and radiological workup was done. Fracture supracondylar humerus was classified according to Gartland’s classification system. Written and informed consent was taken from the guardians of all participants. Regular follow up was done at the end of 1 week, 3 weeks, 6 weeks. Later on patients were followed at the end of one and two years. Flynn’s criteria were used to assess the outcome.[13]. The criteria have two components a) Functional and b) Cosmetic. Each component is further subdivided into excellent, good, moderate and poor at the interval of five degrees. The functional component consists of measuring the arc of motion in a sagittal plane which includes flexion and extension. The cosmetic component consists of measuring of carrying angle which indicates the coronal movement at the elbow joint.

Operative technique: Patient kept in supine position with an affected arm on the armrest and under general anesthesia. Under aseptic condition scrubbing, painting and draping have done. Using traction-counter traction technique fracture supracondylar humerus reduction achieved under IITV guidance and keeping elbow in hyperflexion, K wire (size-1.8mm) pinning done in a divergent manner in lateral entry K wire technique. In the cross pinning technique, lateral K wire insertion done in elbow hyperflexion and medial K wire insertion done in extension to avoid ulnar nerve injury under IITV guidance. After satisfactory reduction K wire was bent and cut ends are kept outside the skin. Above elbow slab is given in 90-degree elbow flexion in all cases. Postoperative limb elevation and monitoring done to assess the neurovascular status and wound dressing done on a postoperative day 2 following which patients were discharged.

Figure-1: Preoperative X-ray

The cross entry Group A comprised of 30 patients. The average age of Group A was 5.1 years. The total numbers of male patients in Group A were22 and female patients were 08 in number. The right elbow was involved in 17 patients whereas the left elbow was involved in 13 patients. One patient was lost to follow-up (Table-1). The lateral entry Group B also comprised of 30 patients. The average age of Group B was 4.8 years. Male patients constituted 20 cases whereas female cases were 10 in number in Group B. The right elbow was involved in 14 patients and the left elbow was involved in 16 patients (Table -1). Flynn’s criteria were applied at the end of the final follow up (02 years). Among Group A(n=29) excellent outcome was seen in 22 cases, Good in 04 cases, fair in 02 cases and poor outcome in 01 cases. The overall satisfactory outcome was in 96.55% of cases and unsatisfactory outcome in 03.45% of cases (Table-2). In Group B (n=30) excellent outcome was seen in 24 cases, Good in 04 cases, Fair in 01case and poor in 01 cases. 96.67% of patients had satisfactory outcome whereas 03.33% had unsatisfactory outcome (Table- 2). There is no statistically significant difference in outcome among both groups (student ‘t’ test,p=0.93). The complication seen in Group A was iatrogenic ulnar nerve praxia in two patients. While in group B pin loosening was seen in one case.

Table 1- Showing patient wise distribution.

Table 2- Showing outcome according to Flynn’s criteria

In Group B 96.67% of cases had satisfactory results and 03.33% cases had unsatisfactory results. There was no significant difference between the functional outcomes of both groups. These results were comparable to the studies done by Yen YM [27].

who found both lateral entry pin fixation (n=28) and medial and lateral entry pin fixation (n=24) are effective in the treatment of completely displaced (type-III) extension supracondylar fractures of the humerus in children. The study conducted by Lokesh Naik et al [26]. showed the functional factor in Group A was satisfactory in 27(96.4%) patients and the functional factor was satisfactory in all the patients of Group B. Another study by Rajesh Govindaswamy[28] et al they found in both techniques, there were excellent functional results with less than 5-degree loss of range of motion in most children (96%).

Rizk et al [29] conducted a study on 50 patients. They found that according to the modified Flynn’s criteria, the functional outcome was excellent in 25 patients in group I, whereas the outcome was excellent in 24 patients and good in one patient in group II. No fair or poor functional or cosmetic outcome was obtained in both groups. There was no significant statistical difference between both groups regarding both the functional (P=0.276).

Ulnar nerve praxia is usually a major concern in patients of cross pinning. In our study we found 2 cases of ulnar nerve praxia in group A. In another study done by Lyons JP et al [21]. they found 6% of patients had nerve injury. Lokesh et al [26]. found that 6.8% of cases in the cross pinning group had ulnar nerve neuropraxia postoperatively and who recovered completely within three weeks of surgery.

However Yen YM does not found any case of ulnar nerve injury in either group.[27]. In another study by Holsam M et al [19]. the incidence of ulnar nerve neuropraxia ranged from 1.4 to 15.6%. The reason suggested by them is that the ulnar nerve becomes vulnerable to injury with elbow flexion because it subluxate over the medial epicondyle.

They have suggested precautions to eliminate the risk of ulnar nerve injury such as fixation from the lateral side only, a small incision over medial epicondyle for direct visualization, insertion of the medial pin with an elbow in some extension. We found a single case of pin loosening in group B. Similar finding were found by Lokesh Gudda et al [26].