The initial recommendation of “limited” was based on the lack of evidence addressing the six critical outcomes that the work group had identified. Pin fixation was shown to be statistically superior to non-operative treatment for two critical outcomes, prevention of cubitus varus and loss of motion.
Among the non-critical outcomes, pin fixation was statistically superior to non-operative treatment in a meta-analysis of Flynn’s Criteria. This outcome incorporates both range of motion and carrying angle. Two non-critical outcomes, infection and pin track infection, favored non-operative treatment because they can only occur in patients who receive operative treatment.
Although operative treatment introduces the risk of infection, the improved critical outcomes combined with the decreased risk of limb threatening ischemic injury outweigh these risks.
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