Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning? A retrospective cohort study

Abstract

Background:The authors compared two techniques for safe medial pin placement during fixation of supracondylar humeral fractures, namely closed pinning and mini-open pinning of medial wire insertion, and their effectiveness in protection against iatrogenic ulnar nerve injury. Methods:One hundred and nineteen patients with type 2 and 3 Gartland supracondylar humeral fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] 13-M/3.1 II, III and IV) were included in this study after applying the exclusion criteria. All patients were managed with cross pinning with identification of two groups. The first group was for percutaneous pinning (N = 63), and the second group for patients with medial open incision during medial wire insertion (N = 56). All patients were evaluated for the incidence of nerve injury after surgery. Results:Nerve injury occurred in 12 of 119 patients. The estimated duration of follow-up was 43.6 ± 10.2 wk. The results revealed nine patients who had ulnar nerve injury among both groups (group 1, N = 8, group 2, N = 1), with statistically better results in group 2 (P = 0.02). The incidence of nerve injury was not found to be correlated with other variables, which included age, gender, type of fracture, number of Kirschner wires that were inserted, and the level of the surgeon. Conclusions:A medial mini-open incision decreased the risk of ulnar nerve injury during cross pin fixation in the treatment of displaced supracondylar humeral fractures, without additional morbidity.

Management of iatrogenic ulnar nerve palsies after cross pinning of pediatric supracondylar humerus fractures: A systematic review

“…1 There is debate in the literature regarding crossed versus lateral wires only for fracture fixation; lateral wires are not as stable but avoid the morbidity of an ulnar nerve injury. 2,3 Iatrogenic ulnar nerve injuries with crossed Kirshnerwires (k-wires) occur in approximately 4% of cases treated with k-wire fixation. 1 This is decreased to 0.4%-1.8% if a mini-open approach is used for the medial wire.…”

“… 1 There is debate in the literature regarding crossed versus lateral wires only for fracture fixation; lateral wires are not as stable but avoid the morbidity of an ulnar nerve injury. 2 , 3 …”

“… 1 This is decreased to 0.4%–1.8% if a mini-open approach is used for the medial wire. 2 , 4 There is no consensus how to treat these iatrogenic nerve palsies. Some authors advocate treatment of the fracture without early intervention; 5 , 6 others advocate for early wire removal or repositioning 7 , 8 and/or early exploration of the ulnar nerve.…”

Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning?: A retrospective cohort study: Erratum

“…In the article, “Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning? : A retrospective cohort study”,1 which appeared in Volume 32, Issue 4 of Current Orthopedic Practice , Dr. Sharaby’s affiliation, Department of Orthopedics and Traumatology, Mansoura University Hospital, Egypt, was not included.…”

Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning?: A retrospective cohort study: Erratum

“…In the article, “Does a medial mini-incision decrease the risk of iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning? : A retrospective cohort study”, 1 which appeared in the July/August 2021 issue of Current Orthopedic Practice, Dr. Mohamed M.F. Sharaby’s affiliation appears incorrectly as Department of Orthopedic Surgery, Khoula Hospital, Muscat, Sultanate of Oman.…”