Introduction: The standard treatment of displaced supracondylar fractures of the distal humerus in children is closed reduction and pin fixation, but the optimal pin configuration is controversial. Crossed-pin fixation of the humerus is mechanically more stable than any other kind of pin configuration, but this fixation may cause iatrogenic ulnar nerve injury. Many authors recommended fixation from the lateral side in order to eliminate this complication. Since 1999, we have been using a 3-pinfixation technique with insertion of the first two pins with the elbow in full flexion, followed by insertion of the third wire through the medial side with the elbow in full extension. We call this the “flexion-extension cross-pinning technique”.

Method: This is a retrospective review of 64 displaced supracondylar fractures fixed by flexion-extension cross pinning.

Results: Eleven children had Gartland type 2 fractures and 53 children had Gartland type 3 fractures. There was no iatrogenic ulnar neve palsy. Loss of reduction in two children was related to technical errors. One patient had superficial pin tract infection.

Conclusion: We feel that this technique and pins configuration is safe and easy to learn. It has become the standard method of fixation of displaced supracondylar fractures in our institution.