Treatment of Displaced Pediatric Supracondylar Humerus Fracture Patterns Requiring Medial Fixation

Abstract

Level III-therapeutic studies.

The displaced supracondylar humerus fracture

“…Overall, incidence rates of iatrogenic ulnar nerve injury range from 0 to 6% [29,[45][46][47][48][49]. As medial fixation may be inevitable for certain fracture patterns, several operative techniques have been described to reduce the risk of ulnar nerve injury [39,49]. Similarly, a recent meta-analysis of randomized controlled trials by Zhao et al [51] supported the assertion that iatrogenic ulnar nerve injury was higher with the crossed pinning technique than with the lateral entry technique.…”

“…It is well known that the crossed pin configuration carries the risk of iatrogenic ulnar nerve injury, whereas lateral pinning carries an increased risk of median neuropathy. Overall, incidence rates of iatrogenic ulnar nerve injury range from 0 to 6% [29,[45][46][47][48][49]. Nerve injury occurred at a weighted event rate of 4.1% where crossed pins were used, whereas the use of lateralonly pinning caused neurapraxia at a weighted event rate of 3.4% [44].…”

Paediatric supracondylar humeral fractures: a technique for safe medial pin passage with zero incidence of iatrogenic ulnar nerve injury

“…(5) This led to the development of the lateral-only configuration, which is favoured by some and involves three lateral pins (proven by Zionts et al (4) to possess almost equal stability as the cross K-wire configuration), two diverging lateral pins by Skaggs et al (6) and two converging lateral pins in Dorgan's technique. (7) Currently, safe medial pin insertion techniques that have been described to minimise iatrogenic ulnar nerve injury include 'milking' the soft tissue posteriorly using the thumb to protect the ulnar nerve and positioning the elbow in extension for medial pin insertion, as mentioned in a textbook (8) and in the study by Edmonds et al (9) The present study further emphasises the importance of these steps and, additionally, refines the technique with attention to details such as pin holding, positioning and passage.…”

Biomechanical comparison of different external fixator configurations for stabilization of supracondylar humerus fractures in children

“…The K-wire must not be inserted in hyperflexion of the elbow to prevent the nerve from subluxating and has to be placed ventrally of the sulcus (Edmonds et al, 2012;Gordon et al, 2001;Skaggs et al, 2001;Zaltz et al, 1996). Even in cases of severe soft-tissue swellings, the ulnar epicondyle can be used as a landmark easy to find (Edmonds et al, 2012;Flynn et al, 1974). If the ulnar nerve cannot be located, the use of a small incision (Gordon et al, 2001;Gosens & Bongers, 2003;Green et al, 2005;Zaltz et al, 1996) or nerve-stimulation is advised (Michael & Stanislas, 1996).…”

“…The risk of damaging the nerve can be reduced to a minimum if the surgeon sticks to the application of certain techniques. The K-wire must not be inserted in hyperflexion of the elbow to prevent the nerve from subluxating and has to be placed ventrally of the sulcus (Edmonds et al, 2012;Gordon et al, 2001;Skaggs et al, 2001;Zaltz et al, 1996). Even in cases of severe soft-tissue swellings, the ulnar epicondyle can be used as a landmark easy to find (Edmonds et al, 2012;Flynn et al, 1974).…”