Shoulder arthroplasty in the setting of previous stabilization surgery: a systematic review of matched case control studies at minimum 2 years follow-up.

Background: Anterior shoulder instability causes considerable patient morbidity and the volume of shoulder stabilization surgery being performed annually is rising. Despite stabilization surgery, instability arthropathy in the long-term may arise requiring consideration of shoulder arthroplasty. This study evaluated the outcomes of shoulder arthroplasty following previous stabilization surgery with their associated changes in bony anatomy or soft tissue structure. Methods: A systematic review was performed as per Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify all studies reporting outcomes of shoulder arthroplasty in the setting of previous stabilization surgery. Studies of >10 patients with a minimum of 24 months follow-up were included. Results: Overall, 377 shoulder arthroplasties composed of 247 anatomical total shoulder arthroplasties (aTSAs), 102 reverse total shoulder arthroplasties (RTSAs), and 28 hemiarthroplasties (HAs) were reported across 14 included studies at mean age 55.4 years, with 203 compared to 451 control shoulders in 7 matched case-control studies. The mean interval from arthroplasty to stabilization procedure was 19.7 years, with 27.2% of patients having undergone multiple procedures and 39.5% bone transfer procedures. Improvements in patient outcomes were observed both for patients who had underwent aTSA or RTSA, with the American Shoulder and Elbow Surgeons score the most commonly used scoring system. Across matched studies comparing to control, large improvements in American Shoulder and Elbow Surgeons were seen for both aTSA and RTSA implants, 38.1-80.5 and 34.9-82.3, which compared to control groups 38.0-85.5 and 35.5-82.3, respectively. There were differences observed in complication profiles between aTSA and RTSA procedures, with lower revision rates in the short-term to medium-term for RTSA implants in present literature. A significantly higher rate of aTSA revision was observed compared to matched control patients undergoing aTSA for primary osteoarthritis without previous stabilization surgery, 9.4% (13/139) vs. 4.1% (11/269) (P = .044). Aseptic loosening posed a particular challenge in the aTSA group, with significantly higher rates of 5.0% (7/139 f = 54.6 months) compared to control 0.74% (2/269 f = 49.1 months, P = .0088). No significant difference in infection rate was observed between matched study and control groups, 1.5% vs. 2.2% (P = .76). Conclusion: Shoulder arthroplasty may improve functional outcomes for patients experiencing instability arthropathy with a history of stabilization surgery. Careful consideration of potential complications is warranted both in surgical planning and patient counselling given the altered anatomy and biomechanics, with significantly higher revision and loosening rates observed following aTSA compared to control.

Retching as an unusual cause of bilateral posterior shoulder fracture dislocation.

Bilateral posterior shoulder fracture dislocation is a debilitating injury and is quite rare. This injury pattern has been described in the literature as either secondary to seizure, electrocution or major trauma. We present a case of an elderly man who appears to have sustained the injury after an episode of retching and vomiting. With our patient witnessed closely throughout and no trauma, electrocution or seizure activity reported, we propose that the violent action of retching and vomiting not only has the potential to cause this injury pattern but also was the only credible cause in our patient. This case not only adds to the list of potential injuries caused by retching and vomiting but also questions the validity of a previously limited list of modes-of-injury for posterior shoulder fracture dislocation.

Perioperative Mortality and Periprosthetic Fracture: A Single-Center Experience of 857 Uncemented Hemiarthroplasties for Displaced Femoral Neck Fractures.

BACKGROUND: Uncemented hemiarthroplasty (UHA) for displaced femoral neck fracture (FNF) is favored by some surgeons because of the reduced rate of perioperative mortality and operative time. However higher rates of intraoperative and postoperative periprosthetic fractures (PPFs) have been reported. The aim of the study was to review day-0, day-1, day-2, day-30, and one-year mortality as well as intraoperative and postoperative PPF after UHA for displaced FNF and compare this with cemented hemiarthroplasties (CHAs) performed. Secondary objectives were to assess whether femoral stem geometry and alignment were associated with PPF in UHA. METHODS: A retrospective observational study was conducted of patients treated with a hemiarthroplasty for a displaced FNF over an eleven-year period. Radiographic analysis was conducted of femoral geometry and stem alignment. RESULTS: Over the 11-year study period, 857 UHAs and 247 CHAs were performed. There were no on-table, day-0, day-1, or day-2 deaths in UHA. Intraoperative PPF occurred in 3.6% UHA and 2% CHA and postoperative PPF in 2.4% UHA and 4.8% CHA. Intraoperative PPF was not associated with increased mortality (P = .15), postoperative PPF, or all-cause revision in UHA. Valgus stem alignment was a risk factor for a postoperative PPF and additional surgery in UHA (P = .004). CONCLUSION: UHA was associated with no perioperative deaths and a 30-day mortality rate of 5% in this series. It can be considered in patients with multiple medical comorbidities. Careful surgical planning and technique is important to optimize stem alignment particularly in Dorr C type femurs.

Ten Inventions That Shaped Modern Orthopedics.

The current field of orthopedics is the result of many decades of minor and major advancements. The evolution of orthopedics has culminated into the modern field seen today. This article presents 10 inventions that played a key role in shaping modern orthopedics.

Arthroscopic anterior shoulder stabilisation in overhead sport athletes: 5-year follow-up.

INTRODUCTION: Shoulder instability following traumatic glenohumeral dislocation is a common injury sustained by athletes particularly in contact and collision sports. Overhead contact sports such as gaelic football and hurling pose a unique hazard to the glenohumeral joint, increasing the risk of dislocation. AIMS: To assess return to sport, level of play, recurrence and functional outcomes in gaelic football and hurling athletes in comparison with players of other sports. METHODS: A retrospective cohort study was carried out from 2007 to 2016. Follow-up was conducted via telephone interview using the Western Ontario Shoulder Instability Index (WOSI) score used to assess functional outcomes as well as return to sport, level of return and recurrence. RESULTS: Ninety patients were included with follow-up which was obtained on 61 patients (68%) with a mean follow-up of 5.04 years. 91.8% played sport at the time of injury, 55.4% of those (31 patients) played a gaelic sport with 44.6% (25 patients) playing other sports. 76.8% returned to their sport, 80.4% of these able to return at their pre-injury level. Recurrence occurred in 10 patients (16.4%). WOSI scores were not significantly different between groups (p = 0.77). No significance in recurrence between groups was noted (p = 0.78). DISCUSSION: Favourable outcomes can be expected for overhead contact sport athletes undergoing anterior arthroscopic stabilisation for recurrent instability. Players from these groups returned to sport sooner than those from other sports and no difference in recurrence was noted. The level at which they can expect to return to is favourable with most athletes reaching their pre-injury level.

The long-term outcomes following internal fixation for intracapsular hip fractures in an Irish tertiary referral centre.

BACKGROUND: The burden associated with hip fractures is increasing worldwide. Arthroplasty procedures are more commonly performed for intracapsular fractures due to increased risk of compromise to the femoral head blood supply. However, we know from the Irish Hip Fracture Database that a significant proportion of these fractures undergo internal fixation. AIMS: We sought to investigate the long-term outcomes for these patients including revision rates, functional outcome and mortality rates. METHODS: All intracapsular fractures treated by internal fixation (IF) from 2005 to 2009 were identified. Pre-operative anatomical fracture location and level of fracture displacement was established. Hospital records were used to record mortality and revision rates. The modified Harris hip score was our primary functional outcome measure. RESULT: One hundred twelve intracapsular fractures underwent IF over a 5-year period. The mean age was 68.6 (range 14-95 years). A mean follow-up time of 8.15 years (range 6.7-10.1 years) was achieved. There was a 5-year mortality rate of 36.6%. There was a significantly higher revision rate in displaced fractures (24.4%) than in undisplaced fractures (11.1%) (p = 0.01). We found no difference in functional outcome between displaced fractures [85.9 (± 16.9)] and undisplaced fractures [86.01 (± 18.8)]. Those aged younger than 65 at the time of surgery had a significantly better MHHS (p = 0.02) at long-term follow-up; however, there was a revision rate of 43.8% in this group. CONCLUSION: Whilst a good functional outcome can be achieved with internal fixation, particularly in younger patients, the risk of requiring revision surgery approaches 50% for these patients.

Hip Fracture in a Patient with Primary Hyperparathyroidism: Medical and Surgical Lessons.

Hyperparathyroidism is a condition which can be primary, secondary or tertiary and is characterized by increased calcium levels, low phosphate levels, and elevated parathyroid hormone (PTH) levels. Primary hyperthyroidism can cause severe bone resorption leading to bone pains and pathological fracture. We present the case of a patient with severe primary hyperparathyroidism with an atraumatic fracture at the neck of the femur and multiple medical comorbidities presenting a surgical challenge. While primary hyperparathyroidism is rare, it should be considered during differential diagnoses.

Giant Cell Tumour of Knee Popliteus Muscle Synovial Sheath.

The giant cell tumour of the tendon sheath (GCTTS) is the second most common soft tissue benign tumour and rarely presents in the knee. We report a rare presentation of a GCTTS in the knee with corresponding magnetic resonance imaging (MRI), an arthroscopic picture, and histological presentation. It is a rare occurrence but should be considered as a differential in atraumatic knee pain presentation. This case report gives a classic picture of its presentation, diagnosis, and histopathology.

Focal intratendinous radiolucency: A new radiographic method for diagnosing patellar tendon ruptures.

BACKGROUND: Diagnosis of patellar tendon rupture is usually based on clinical history and examination. In equivocal cases, imaging may be required. Lateral radiograph is a simple and cost-effective method for prompt diagnosis. However, no specific radiological sign has been described. Rather than utilising patella alta as an indirect measure of patellar tendon rupture, we hypothesise that a focal intratendinous radiolucency is another reliable and accurate radiological sign for diagnosis. Sensitivity and specificity analysis was undertaken to evaluate the diagnostic value of this radiographic sign. METHODS: Lateral radiographs of mid-substance patellar tendon ruptures from 19 patients were analysed. These were then randomised with another 19 normal knee radiographs from age-matched patients to create a pool of 38 radiographs for interpretation. Six independent interpreters who were blinded to the diagnosis were requested to indicate whether rupture was present or absent based on the visualisation of a focal intratendinous radiolucency in the patellar tendon. The Insall-Salvati (IS), Caton-Deschamps (CD) and Blackburne-Peel (BP) ratios were measured in the same radiographs. Sensitivity and specificity for each of the radiographic measurements were calculated. Inter- and intraobserver correlations were reported in kappa statistics. RESULTS: The average sensitivity and specificity for focal radiolucency in the patellar tendon substance were 82.5% and 95.2%, respectively. Sensitivity and specificity for the IS ratio were 84.2% and 78.9%, for CD was 68.4% and 84.2% and for BP was 68.4% and 89.4% respectively. CONCLUSION: The presence of a focal intratendinous radiolucency in the patellar tendon is both accurate and reliable in diagnosing patellar tendon ruptures.

Influence of weather variables on pain severity in end-stage osteoarthritis.

PURPOSE: Patients often attribute increasing pain in an arthritic joint to changing weather patterns. Studies examining the impact of weather on pain severity have yielded equivocal and sometimes contradictory results. The relationship between subchondral pseudocysts and the role they play in this phenomenon has not been explored. METHODS: Fifty-three patients with end-stage osteoarthritis of the hip completed daily pain severity visual analogue scale (VAS) scores over a one month period. Radiographs were reviewed to determine the presence of pseudocysts. Data pertaining to precipitation, atmospheric pressure and temperature were collected from the nearest weather station. A generalised linear mixed model was used to explore the relationship between weather variables, cysts and pain severity. RESULTS: Pain levels increased as a function of absolute change in atmospheric pressure from one day to the next. Precipitation, temperature and the presence of subchondral pseudocysts were not shown to influence pain severity. CONCLUSIONS: This data supports the belief held by many osteoarthritic patients that changing weather patterns influence their pain severity.

Full and surface tibial cementation in total knee arthroplasty: a biomechanical investigation of stress distribution and remodeling in the tibia.

BACKGROUND: Aseptic tibial component loosening remains a major cause of total knee arthroplasty failure. The cementation technique used to achieve fixation may play a major role in loosening. Despite this, the optimum technique remains unanswered. This study aims to investigate stress and strain distributions in the proximal tibia for full cementation and surface cementation of the Genesis II tibial component. METHODS: Principal cortical bone strains were measured experimentally in intact, surface cemented and fully cemented synthetic tibiae using strain gauges. Both axial and 15° flexion loading were considered. Finite element models were used to assess both cortical and cancellous bone stresses and strains. Using a bone remodeling algorithm potential sites of bone formation and resorption were identified post-implantation. FINDINGS: Principal cortical bone strain results demonstrate strong correlations between the experimental and finite element analyses (R(2)≥0.81, RMSE(%)≤17.5%). Higher cortical strains are measured for surface cementation, as full cementation creates a stiffer proximal tibial structure. Simulations reveal that both cementation techniques result in lower cancellous stresses under the baseplate compared to the intact tibia, with greater reductions being computed for full cementation. The surface cementation model displays the closest cancellous stress distribution to the intact model. In addition, bone remodeling simulations predict more extensive bone resorption under the baseplate for full cementation (43%) than for surface cementation (29%). INTERPRETATION: Full cementation results in greater stress reduction under the tibial baseplate than surface cementation, suggesting that surface cementation will result in less proximal bone resorption, thus reducing the possibility of aseptic loosening.

Advancing regenerative surgery in orthopaedic sports medicine: the critical role of the surgeon.

The constant desire to improve outcomes in orthopaedic sports medicine requires us to continuously consider the challenges faced in the surgical repair or reconstruction of soft tissue and cartilaginous injury. In many cases, surgical efforts targeted at restoring normal anatomy and functional status are ultimately impaired by the biological aspect of the natural history of these injuries, which acts as an obstacle to a satisfactory repair process after surgery. The clinical management of sports injuries and the delivery of appropriate surgical intervention are continuously evolving, and it is likely that the principles of regenerative medicine will have an increasing effect in this specialized field of orthopaedic practice going forward. Ongoing advances in arthroscopy and related surgical techniques should facilitate this process. In contrast to the concept of engineered replacement of entire tissues, it is probable that the earliest effect of regenerative strategies seen in clinical practice will involve biological augmentation of current operative techniques via a synergistic process that might be best considered "regenerative surgery." This article provides an overview of the principles of regenerative surgery in cartilage repair and related areas of orthopaedic surgery sports medicine. The possibilities and challenges of a gradual yet potential paradigm shift in treatment through the increased use of biological augmentation are considered. The translational process and critical role to be played by the specialist surgeon are also addressed. We conclude that increased understanding of the potential and challenges of regenerative surgery should allow those specializing in orthopaedic surgery sports medicine to lead the way in advancing the frontiers of biological strategies to enhance modern clinical care in an evidence-based manner.

Dorgan's lateral cross-wiring of supracondylar fractures of the humerus in children: A retrospective review.

INTRODUCTION: The currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The purpose of this study was to retrospectively review a novel cross-wiring technique where the cross-wire configuration is achieved solely from the lateral side, thereby reducing the risk of ulnar nerve injury. METHODS: We retrospectively reviewed all children who had undergone this procedure at our centre over a 10-year period. The primary end points were a major loss of reduction as determined by radiological alignment and iatrogenic ulnar nerve injury. Secondary end points included clinical alignment, elbow range of motion and complications. RESULTS: A total of 43 patients, who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type II and type III) of the humerus were reviewed with a mean follow-up time of 36 months. No major loss of reduction occurred. The mean change in Baumann's angle (4.2+/-1.6 degrees) between intra-operative and follow-up radiographs was not significant (p>0.05). No iatrogenic case of ulnar nerve injury occurred. The 'carrying angle' and 'return to function' in all children had returned to normal relative to the other side. Postoperative complications consisted of three patients developing pin-site infections, which were successfully treated. CONCLUSION: Dorgan's lateral cross-wiring technique is an effective option in treating displaced supracondylar fractures of the humerus in children. It is as effective as the traditional cross-wire technique in terms of fracture healing with a reduced risk of ulnar nerve injury.

Changes in the length of virtual anterior cruciate ligament fibers during stability testing: a comparison of conventional single-bundle reconstruction and native anterior cruciate ligament.

BACKGROUND: Conventional tunnel positions for single-bundle (SB) transtibial anterior cruciate ligament (ACL) reconstruction are located in the posterolateral (PL) tibial footprint and the anteromedial (AM) femoral footprint, resulting in an anatomic mismatch graft that is more vertical than native fibers. This vertical mismatch position may significantly influence the ability of an ACL graft to stabilize the knee. HYPOTHESIS: Anatomic ACL fibers undergo a greater change in length during anterior translation and internal rotation than a conventional SB reconstruction from the PL tibial footprint to the AM femoral footprint. STUDY DESIGN: Controlled laboratory study. METHODS: The Praxim ACL Surgetics navigation system was used to acquire kinematic data during a flexion/extension cycle and to register all points within the ACL footprint from 5 fresh-frozen cadaveric knees. Virtual fibers were placed in the center of the AM and PL bundles as well as central and conventional SB positions. After transection of the ACL, the absolute length change and apparent strain of the fibers were computed for each knee during the Lachman and anterior drawer tests and internal rotation at 0 degrees and 30 degrees of flexion. RESULTS: Each of the anatomic fibers (AM, PL, and central) had more elongation and apparent strain than the conventional SB fiber during the Lachman maneuver. During the anterior drawer test, the AM and central (but not the PL) fibers lengthened significantly more and the AM had more apparent strain than the conventional SB fiber. During internal rotation at 0 degrees and 30 degrees of flexion, anatomic fibers elongated significantly more than the conventional fiber. Except for the AM fiber with the knee at full extension, apparent strain was greater in all anatomic fibers than in the conventional SB fiber during internal rotation maneuvers. CONCLUSION: In ACL-deficient cadaveric knees, anatomic fibers undergo greater elongation and apparent strain in response to anterior translation and internal rotation maneuvers than a conventional SB graft. Because of their optimal orientation, anatomic fibers may resist pathologic anterior translation and internal rotation more than the conventional SB position. CLINICAL RELEVANCE: Conventional placement of a single-bundle graft results in suboptimal changes in fiber length and strain, suggesting that alternatives such as anatomic placement of an SB graft or double-bundle reconstruction may result in greater control of translation and rotation.

Comparison of 3-dimensional obliquity and anisometric characteristics of anterior cruciate ligament graft positions using surgical navigation.

BACKGROUND: Surgical navigation allows continuous intraoperative monitoring of ACL graft anisometry and 3-dimensional obliquity. However, normative anisometry and obliquity measurements for different single-bundle anterior cruciate ligament graft positions are not well described. HYPOTHESIS: ACL Grafts placed in anteromedial and posterolateral bundle positions will have distinct anisometric profiles and 3-dimensional obliquities. A graft placed centrally in anterior cruciate ligament insertion sites will have different obliquity and anisometry than a conventional (single-bundle) graft extending from the tibia's posterolateral aspect to the femur's anteromedial aspect. STUDY DESIGN: Controlled laboratory study. METHODS: Five cadaveric knees were tested. A surgical navigation system was used to create 4 virtual graft positions in the anterior cruciate ligament footprint: (1) anteromedial, (2) posterolateral, (3) central, and (4) posterolateral tibia to anteromedial femur (conventional). Obliquity at various flexion angles and anisometry of each virtual graft's central fiber were determined. RESULTS: Anteromedial and posterolateral fibers are relatively parallel up to 30 degrees of flexion. At higher degrees of flexion, the anteromedial position is more oblique in the sagittal plane, while the posterolateral position is more oblique in the axial plane. The conventional single-bundle position is significantly more vertical than the central position in multiple planes throughout the range of motion. The anteromedial fiber is most isometric, while the posterolateral fiber is the least isometric at all flexion angles. There is no significant difference in the anisometry between the central or conventional positions at any flexion angle. The posterolateral, central, and conventional fibers were longest at full extension and slackened with progressive flexion. CONCLUSION: Anteromedial and posterolateral graft positions can be distinguished by sagittal and axial plane obliquity at flexion angles >30 degrees and by anisometry measurements. Conventional positioning produces a relatively vertical graft placement compared with the central position but has similar anisometry characteristics. Our data suggest that posterolateral, central, and conventional grafts should be fixed at or near full extension to avoid excessive tightening during motion. CLINICAL RELEVANCE: This study provides anisometry and 3-dimensional obliquity data for various graft positions using surgical navigation. The failure of single-bundle anterior cruciate ligament reconstruction to restore intact knee kinematics may be partly due to the relative vertical placement of conventional grafts compared with the central anterior cruciate ligament footprint position.

A novel surface treatment for porous metallic implants that improves the rate of bony ongrowth.

Rapid implant fixation could prove beneficial in a host of clinical applications from total joint arthroplasty to trauma. We hypothesized that a novel self-assembled monolayer of phosphonate molecules (SAMP) covalently bonded to the oxide surface of titanium alloy would enhance bony integration. Beaded metallic rods were treated with one of three coatings: SAMP, SAMP + RGD peptide, or hydroxyapatite. Rods were inserted retrogradely into both distal femurs of 60 rabbits. Fifteen rabbits were sacrificed at 2, 4, 8, and 16 weeks. At each time, seven specimens for mechanical pull-out testing and three for histomorphometric analysis were available for each coating. At four weeks, both SAMP groups had significantly higher failure loads when compared to hydroxyapatite (p < 0.01). No significant differences were found among groups at other times, though the SAMP-alone group remained stronger at 16 weeks. Histology showed abundant new bone formation around all the three groups, though more enhanced formation was apparent in the two SAMP groups. With this novel treatment, with or without RGD, the failure load of implants doubled in half the time as compared with hydroxyapatite. Where early implant fixation is important, the SAMP treatment provides a simple, cost-effective enhancement to bony integration of orthopaedic implants.

The role of the high tibial osteotomy in the unstable knee.

High tibial osteotomy is an accepted treatment option for knee arthrosis in association with coronal malalignment. However, the effect of this procedure on the sagittal balance of the knee has until recently been largely ignored. Basic science research over the past several years and some small clinical series have introduced a "novel" concept whereby the sagittal balance of a ligament deficient knee can be restored to some degree by altering the posterior tibial slope. This review summarizes the available evidence supporting the role of selective high tibial osteotomy in the treatment of both the acute and chronic ligament deficient knee.

Biomechanical analysis of anterior poly-methyl-methacrylate reconstruction following total spondylectomy for metastatic disease.

STUDY DESIGN: Three reconstruction options were evaluated biomechanically following total spondylectomy using human cadaveric spine specimens. OBJECTIVES.: To evaluate and compare the stability of combined anterior and posterior fixation incorporating poly-methyl-methacrylate with alternative accepted reconstruction techniques. SUMMARY OF BACKGROUND DATA: Total spondylectomy represents the most radical option for decompression in metastatic spinal cord compression. Poly-methyl-methacrylate is considered a useful adjunct in spinal column stabilization and arthrodesis; however, there is little published biomechanical data to support its use in this setting. METHODS: Ten fresh-frozen human cadaveric spines (T9-L3) were used. After intact analysis, a total spondylectomy was performed at T12. Three potential reconstruction techniques were tested for their ability to restore stiffness to the specimen: 1) multilevel posterior pedicle screw instrumentation from T10-L2; 2) anterior instrumentation (ATL Z plate II) and rib graft at T11-L1 with multilevel posterior pedicle screw instrumentation from T10-L2; and 3) anterior cement (Simplex P) and pins construct (T12) with multilevel posterior pedicle screw instrumentation from T10-L2. Each of the three potential reconstruction techniques was tested on each specimen in random order using nondestructive testing under load control. RESULTS: Only combined stabilization techniques (e.g., anterior instrumentation and rib graft with multilevel posterior pedicle screw instrumentation and anterior cement-and-pins construct with multilevel posterior pedicle screw instrumentation) restored stiffness to a level equivalent to or higher than that of the intact spine in all loading modes (P < 0.05). Anterior cement-and-pins construct with multilevel posterior pedicle screw instrumentation provided more stability to the specimen than anterior instrumentation and rib graft with multilevel posterior pedicle screw instrumentation in compression and flexion testing (P < 0.05). Posterior instrumentation alone did not restore stiffness to the intact level in compression and flexion testing (P < 0.005). CONCLUSIONS: Combined anterior and posterior reconstruction using a cement construct provides equal to or more stability than the intact spine in all testing modes. Posterior stabilization alone is an inferior method of reconstruction following total spondylectomy. Poly-methyl-methacrylate has the advantage over traditional anterior reconstruction techniques in that it can be inserted using a posterior approach.

"Dorgan's" percutaneous lateral cross-wiring of supracondylar fractures of the humerus in children.

The preferred treatment of displaced supracondylar humeral fractures in children is closed reduction and percutaneous pinning. Cross-wiring techniques are biomechanically superior to parallel lateral wiring techniques. The purpose of this study was to review the authors' experience with a novel cross-wiring technique performed entirely from the lateral side. Twenty children with supracondylar fractures who were manipulated and wired using a lateral cross-wiring technique were reviewed. Patient demographics, mechanism of injury, fracture classification, and associated neurovascular injuries were noted. All fractures were reduced, cross-wired from the lateral side, and rested in an above-elbow slab. Wires were removed at 4 weeks. Range of motion and carrying angle were measured at follow-up. Lateral cross-wiring of supracondylar fractures represents a real option in the treatment of these injuries, offering the biomechanical advantages of traditional cross-wiring without the risk of ulnar nerve injury.