Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children

Eberl, Robert; Eder, Christian; Smolle, Elisabeth; Weinberg, Annelie M.; Höellwarth, Michael E.; Singer, Georg

doi:10.3109/17453674.2011.623574

Cited by 29 publications

(30 citation statements)

References 22 publications

(33 reference statements)

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“…Persistent postsurgical pain (PPP) with features of NP has been well described in adults presumably due to inadvertent operative trauma to nervous tissue 28 29. PPP has been reported in children, but the overall incidence, role of NP or relevance of age at the time of surgery is not known 30 31. In adults who had had inguinal hernia repair before 5 years of age, persistent pain was reported in 13.5% in one study 32.…”

Section: Introductionmentioning

confidence: 99%

Neuropathic pain in children

Howard

Wiener

Walker

2013

Archives of Disease in Childhood

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Neuropathic pain (NP), due to a lesion or disease of the somatosensory nervous system, is not well documented or researched in children. NP is a clinical diagnosis that can be difficult, especially in younger children. Nevertheless, it is important to recognise NP, as pain mechanisms and consequently management and prognosis differ from other types of long-term pain. NP is common in adult pain clinics but many of the underlying disease states in which it occurs are infrequently or never encountered in paediatric practice. However, NP in childhood has been reported, even in the very young in certain clinical situations. Causes of NP include traumatic injury, complex regional pain syndrome type II, cancer and chemotherapy, chronic infection, neurological and metabolic disease, and inherited sensory nerve dysfunction. The clinical and laboratory study of traumatic peripheral nerve injury has revealed important age-related differences in clinical presentation and prognosis. It is clear that mechanisms operating during development can profoundly modify the consequences of nerve damage and NP. Clinically, diagnosis, assessment and treatment of NP are based on methods and evidence derived from data in adults. Improvements in the understanding and management of NP are likely to come from developmentally appropriate improvements in the clarity and consistency of diagnosis and systematic, well-researched approaches to treatment.

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Section: Introductionmentioning

confidence: 99%

Neuropathic pain in children

Howard

Wiener

Walker

2013

Archives of Disease in Childhood

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“…Open reduction of pediatric supracondylar humerus fractures has been associated with increased complications and poorer outcomes, often reported using the criteria of Flynn et al [3,5,6,9,10,12,13]. Several operative tricks and techniques have been described in the literature, but to our knowledge, no study has been designed to show a decrease in the need for open reduction with these techniques [4,7,11,17]. Our technique of Schanz pin placement in the posterior humeral diaphysis was associated with a reduction in the conversion rate to an open procedure and in operative time without affecting final radiographic alignment or complications.…”

Section: Discussionmentioning

confidence: 73%

“…They concluded that their two minimally invasive reduction techniques were advantageous over conventional open reduction and internal fixation. Eberl et al reported on antegrade nailing of displaced pediatric supracondylar humerus fractures and described 9% ''good'' and 91% ''excellent'' results, according to the LinscheidWheeler score [4]. Prone positioning was described by Fowler and Marsh to assist with fracture reduction, and they reported all fractures healed without loss of reduction [7].…”

Section: Introductionmentioning

confidence: 99%

Mid-America Orthopaedic Association Physician in Training Award: Surgical Technique: Pediatric Supracondylar Humerus Fractures: A Technique to Aid Closed Reduction

Herzog

Oliver

Ringler

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Anatomic reduction of some displaced pediatric supracondylar humerus fractures is not attainable via closed manipulation, thus necessitating open reduction. Open reduction has been associated with increased complications, including elbow stiffness, scarring, iatrogenic neurovascular injury, and longer hospital stays. Using a Schanz pin to aid in closed reduction may decrease the need for conversion to an open procedure, possibly reducing morbidity. Description of Technique A percutaneously placed 2.5-mm Schanz pin was drilled into the posterior humeral diaphysis and used as a joystick to reduce anterior and posterior, varus and valgus, and rotational deformity. The fracture then was stabilized with 0.62-mm K-wires placed under fluoroscopy and the Schanz pin then was removed. Methods We retrospectively reviewed all displaced pediatric supracondylar humerus fractures treated by one surgeon from March 2002 through December 2010, with 143 fractures meeting criteria for inclusion. These fractures then were divided into two groups. Group 1 (90 fractures) included fractures treated before implantation of the Schanz pin. In this group, if successful reduction could not be achieved via closed manipulations, a formal open reduction was performed. In Group 2, (53 fractures) the Schanz pin technique was used to assist with reduction of fractures that were not reduced successfully by closed manipulations. All fractures were stabilized with the 0.62-mm K-wires after the reductions. To equalize group size, the 37 most remote fractures in Group 1 were removed, leaving a final 53 fractures in each group for analysis. Demographics, injury data, operative technique, complications, and radiographic reduction were analyzed. The minimum followup for both groups was 3.3 weeks (average, 13 weeks; range, 3.3-130 weeks). Results Fewer fractures in Group 2 (one of 53, 1.9%) compared with Group 1 (seven of 53, 13%) underwent open reduction. Ten fractures in Group 2 underwent the Schanz pin technique, and none of these had open reductions. We found no difference between the groups concerning fracture alignment at final followup or postoperative complications.

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“…20 % und in manchen Serien sogar mit bis zu 50 % beschrieben [19]. Die Kirschner-Draht-Osteosynthese kann folgende Probleme hervorrufen: Infektionen im Bereich der Pinaustrittsstellen, Perforation der Pinenden (0-17%), die iatrogene Gefäßverletzung (0-3 %), iatrogene Nervenverletzung insbesondere des N. ulnaris (0-5 %) [22], Fehlstellung (1-10 %), Materiallockerung (3-10 %) [1]. Bezüglich des Komplikationsrisikos sollte man zwischen jüngeren Kindern (< 8 Jahre) und präadoleszenten Kindern unterscheiden (9-12 Jahre).…”

Section: Konservative Therapieunclassified

Behandlungsstrategien bei der suprakondylären Humerusfraktur im Kindesalter – Bewährtes und Kontroverses

2014

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Elbow fractures are the 2nd most frequent fractures in children. Their therapy needs high expertise. Particularly an adequate analgesic therapy as well as an efficient and differentiated non-surgical or surgical therapy depending on the fracture type needs to be chosen. Secondary damage, especially growth disturbances, has to be prevented. Type I fractures can be managed conservatively with a cast. The crossed percutaneous pin fixation after open or closed reduction is the typical and most frequent surgical treatment option in supracondylar humeral fractures in children. Another good treatment option for supracondylar fractures type II to IV after closed reduction is the elastic-stable intramedullar nailing (ESIN). It is a minimally invasive treatment away from the fracture zone, which allows immediate free movement of the extremity. An immobilisation in a cast is therefore not necessary. That are the most possible effects (opinion of the authors) of the ESIN method, but discussed controversial in the literature. Especially neurovascular concomitant injuries require a differentiated treatment strategy to prevent long-term damage and should only be carried out in a specialised paediatric surgery unit. Long-term complications of supracondylar fractures are limitations in range of motion, nerval palsies, disturbances of growth, as well as cubitus varus (30 %) and valgus (3-7 %). These last ones often result from an insufficient initial anatomic reduction. The aim of the therapy should in any case be a patient-orientated treatment with the expected quickest recovery time and lowest long-term complications. Therefore supracondylar fractures should be treated only by a specialised paediatric trauma team, which can provide all non-surgical and surgical treatments. The spontaneous correcture is only seen in the sagittal view in young children between 6-7 years of age.

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Iatrogenic ulnar nerve injury after pin fixation and after antegrade nailing of supracondylar humeral fractures in children

Cited by 29 publications

References 22 publications

Neuropathic pain in children

Neuropathic pain in children

Mid-America Orthopaedic Association Physician in Training Award: Surgical Technique: Pediatric Supracondylar Humerus Fractures: A Technique to Aid Closed Reduction

Behandlungsstrategien bei der suprakondylären Humerusfraktur im Kindesalter – Bewährtes und Kontroverses

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