Iatrogenic Radial Nerve Injury With Cannulated FixationofMedial Epicondyle Fractures in the PediatricHumerus

Marcu, David M.; Balts, Joshua; McCarthy, James J.; Kozin, Scott H.; Noonan, Kenneth J.

doi:10.1097/bpo.0b013e318209287d

Cited by 25 publications

(10 citation statements)

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“…The radial nerve’s localization has been the subject of much concern due to the potential for pathologic[1,2], traumatic[3,4], and iatrogenic[5-7] injuries. Radial nerve localization has been described relative to a distance from various bony landmarks: The acromion and lateral epicondyle[8] proximal to the elbow and the bicipital tuberosity distal to the elbow[9].…”

Section: Introductionmentioning

confidence: 99%

Posterior interosseous nerve localization within the proximal forearm - a patient normalized parameter

Kamineni

Norgren

Davidson

et al. 2017

WJO

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AIMTo provide a “patient-normalized” parameter in the proximal forearm.METHODSSixty-three cadaveric upper extremities from thirty-five cadavers were studied. A muscle splitting approach was utilized to locate the posterior interosseous nerve (PIN) at the point where it emerges from beneath the supinator. The supinator was carefully incised to expose the midpoint length of the nerve as it passes into the forearm while preserving the associated fascial connections, thereby preserving the relationship of the nerve with the muscle. We measured the transepicondylar distance (TED), PIN distance in the forearm’s neutral rotation position, pronation position, supination position, and the nerve width. Two individuals performed measurements using a digital caliper with inter-observer and intra-observer blinding. The results were analyzed with the Wilcoxon-Mann-Whitney test for paired samples.RESULTSIn pronation, the PIN was within two confidence intervals of 1.0 TED in 95% of cases (range 0.7-1.3 TED); in neutral, within two confidence intervals of 0.84 TED in 95% of cases (range 0.5-1.1 TED); in supination, within two confidence intervals of 0.72 TED in 95% of cases (range 0.5-0.9 TED). The mean PIN distance from the lateral epicondyle was 100% of TED in a pronated forearm, 84% in neutral, and 72% in supination. Predictive accuracy was highest in supination; in all cases the majority of specimens (90.47%-95.23%) are within 2 cm of the forearm position-specific percentage of TED. When comparing right to left sides for TEDs with the signed Wilcoxon-Mann-Whitney test for paired samples as well as a significance test (with normal distribution), the P-value was 0.0357 (significance - 0.05) indicating a significant difference between the two sides.CONCLUSIONThis “patient normalized” parameter localizes the PIN crossing a line drawn between the lateral epicondyle and the radial styloid. Accurate PIN localization will aid in diagnosis, injections, and surgical approaches.

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Section: Introductionmentioning

confidence: 99%

Posterior interosseous nerve localization within the proximal forearm - a patient normalized parameter

Kamineni

Norgren

Davidson

et al. 2017

WJO

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“…1). During the initial operation, the mean age of the children was nine (median, 10.5; range, 6-14) in group A and 15 (16,(10)(11)(12)(13)(14)(15)(16)(17) years in group B. The mean follow-up was 10 (median, 11; range, 6-15) in group A and 10 (9.5, 5-15) years in group B.…”

Section: Methodsmentioning

confidence: 99%

Long-term comparative study of internal fixation with Kirschner wires or cannulated screws for displaced medial epicondyle fractures of the humerus in children: a 10-year follow-up of 42 cases

Ergin

Demіrel

Şentürk

et al. 2020

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: The rationale behind the decision-making on which type of fixation to use in displaced medial epicondyle fractures is not well elucidated. This study aims to compare the long-term clinical and radiographic outcomes of internal fixation with either Kirschner wires (K-wires) or cannulated screws in children with displaced medial epicondyle fractures. METHODS: In this study, 42 consecutive children who underwent surgical treatment for medial epicondyle fractures displaced more than 5 mm were categorized into two groups as follows: group A, 22 children undergoing fixation with K-wires and group B, 20 children undergoing fixation with a screw. The mean age was nine (median, 10.5; range, 6-14) years in group A and 15 (16, 10-17) in group B. The overall follow-up was 10 (median, 10; range, 5-15) years. To assess patients' clinical outcomes, the Mayo Elbow Performance Scores (MEPS) were used in addition to the elbow range of motion (ROM) at the last follow-up. During the radiographic assessment, possible deformities secondary to the epicondyle fracture were examined on final follow-up radiographs. RESULTS: The main MEPS were 95 (median, 95; range, 85-100) and 93 (94, 85-100) in groups A and B, respectively (p=0.18). In ROM, no significant differences were observed (p=0.43). In the radiographic assessment, one patient from each group developed a fibrous union, and one from each group had hypoplasia. There was no significant relationship between the deformity and fixation type (p=0.34, χ 2 test). CONCLUSION: Two smooth K-wires for younger children and screw fixation for children near skeletal maturity may provide favorable clinical and radiological outcomes at long-term follow-up, with low morbidity and radiographic deformity.

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“…Anakwe et al [31] reported delayed ulnar neuropathy after screw fixation in two patients, both of whom required a secondary procedure to decompress the ulnar nerve palsy, with complete recovery between 18 months and 2 years. Marcu et al [32] reported two cases of radial neuropathy, likely caused by the end of a threaded guide pin inadvertently advanced into anterolateral soft tissues.…”

Section: Operative Managementmentioning

confidence: 99%

Medial epicondyle fractures in children

Pathy

Dodwell

2015

Current Opinion in Pediatrics

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Medial epicondyle fractures of the distal humerus account for 12% of pediatric elbow fractures and are frequently associated with intra-articular incarceration of the fracture fragment, elbow dislocation, ulnar nerve injury, and other upper extremity fractures. Recent literature calls into question the accuracy of measuring fracture displacement, and controversy exists regarding optimal management of these fractures. Good outcomes have been achieved with nonoperative treatment for minimally displaced fractures, despite a high rate of nonunion. In patients with displaced fractures, fixation yields stability, functional range of motion, and the ability to return to previous activity levels, including sports. Complications include stiffness, instability, deformity, superficial wound infections, and symptomatic nonunion. Further study is required to standardize the measurement of displacement and to clarify indications for operative treatment in both sedentary and active children.

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Iatrogenic Radial Nerve Injury With Cannulated FixationofMedial Epicondyle Fractures in the PediatricHumerus

Abstract: IV, Case Series.

Cited by 25 publications

References 0 publications

Posterior interosseous nerve localization within the proximal forearm - a patient normalized parameter

Posterior interosseous nerve localization within the proximal forearm - a patient normalized parameter

Long-term comparative study of internal fixation with Kirschner wires or cannulated screws for displaced medial epicondyle fractures of the humerus in children: a 10-year follow-up of 42 cases

Medial epicondyle fractures in children

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