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Lyons, James P.; Ashley, Edwin; Hoffer, M. Mark

doi:10.1097/00004694-199801000-00009

Cited by 72 publications

(18 citation statements)

References 7 publications

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“…Data pooled from 1455 patients found that the incidence of ulnar nerve iatrogenic injury was 5.04 times higher in medial/lateral wire fixation compared to lateral entry fixation [11]. There is also concern about delayed iatrogenic nerve injury using medial wires [23]. …”

Section: Discussionmentioning

confidence: 99%

“…On placing medial wires, surgeons may choose to use a closed, miniopen, or open technique depending on their level of experience and current practice. Advocates of the crossed wire technique state this may convey increased biomechanical stability but the ulnar nerve is at risk from the medial wire [15, 16]. With lateral entry only, iatrogenic injury to the ulnar nerve should be avoided but the construct may be biomechanically less stable [17–20].…”

Section: Introductionmentioning

confidence: 99%

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Lateral Entry Fixation Using Three Divergent Pins for Displaced Paediatric Supracondylar Humeral Fractures

et al. 2011

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Background. Supracondylar fractures are the commonest elbow injury in children. Most displaced supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. This clinical study has results purely from a three lateral divergent wire technique. Methods. Displaced supracondylar fractures were manipulated closed and three lateral divergent wires inserted. Primary study end points were range of movement and carrying angle relative to the contralateral uninjured elbow (Flynn's grading system) and presence of iatrogenic nerve or vessel injury. Results. 25 children between 3 and 10 years (median 5, range 3–10) suffered a displaced fracture (15 type III, 10 type IIB). 15 left-, 10 right-sided fractures, 14 boys and 11 girls). 23 were fixed primarily, of these 21 in the first 24 hours. 2 were delayed due to swelling. 2 were fixed secondarily with lateral k-wires after loss of position (from a primarily fixed crossed wire technique). One radial and one median nerve palsy sustained at injury settled. No iatrogenic nerve injuries occurred. 21 Excellent, 3 good and 1 poor result on Flynn's grading. Conclusions. The use of three wires on the lateral side in this cohort showed no evidence of slip in fracture position and no iatrogenic nerve injury.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lateral Entry Fixation Using Three Divergent Pins for Displaced Paediatric Supracondylar Humeral Fractures

et al. 2011

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“…Ulnar nerve palsy after percutaneous cross-pinning of supracondylar fractures [9] and after trampoline injuries [10] have also been reported but, to the best knowledge of the authors, this is the first case reported in the literature which documents a case of ulnar nerve injury due to comminuted fracture of the humerus shaft.…”

Section: Discussionmentioning

confidence: 99%

Ulnar nerve injury after a comminuted fracture of the humeral shaft from a high-velocity accident: a case report

et al. 2012

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IntroductionInjury to the ulnar nerve following humerus shaft fracture is a very rare entity because the ulnar nerve is well protected from the bone by muscle and soft tissue, and thus remains unaffected in these fractures. We report what is, to the best of our knowledge, the first case of ulnar nerve injury due to a comminuted humeral shaft fracture. The injury manifested and was diagnosed the day after a high-velocity accident. The paucity of related literature and the necessity for early diagnosis and subsequent treatment of such injuries in high-velocity accidents urged us to document this case.Case presentationA 30-year-old Indian man presented to our Emergency Department after a road traffic accident. Our patient complained of right arm pain and the inability to move his extremity. The following morning he developed clawing. Nerve conduction studies on the peripheral nerves of his arm in addition to an X-ray confirmed the diagnosis of a possible injury to the ulnar nerve. Our patient was taken to our Operating Room for surgery, during which a fragment of bone was found abutting the ulnar nerve after penetrating his triceps. This fragment of bone was replaced and the fracture was reduced by open reduction and internal fixation using a dynamic compression plate and screws. Postoperatively, our patient received physical therapy and was discharged two weeks after surgery with no neurological deficit.ConclusionsThis case emphasizes the urgency and importance of careful neurological examination of all the peripheral nerves supplying the arm in patients with a fracture of the shaft of the humerus. In the setting of injury to the arm in high-velocity accidents, a differential diagnosis of ulnar nerve injury should always be considered.

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“…A routine surgical exploration of the nerve is not recommended, but an incision over the medial epicondyle may to be useful in order to detect the ulnar groove and facilitate correct pin placement (Yen and Kocher 2008). Nevertheless, damage to the ulnar nerve is a well-known complication and affects between 2% and 20% of patients treated with crossed fixation (Lyons et al 1998). We can confirm the high rate of ulnar nerve injuries after treatment with crossed pinning.…”

Section: Discussionmentioning

confidence: 99%

“…Different techniques have been reported, but crossed pinning with postoperative immobilization is the preferred technique (Brauer et al 2007, Kocher et al 2007, Zamzam and Bakarman 2009). Iatrogenic injury to the ulnar nerve has been described in up to 20% of the cases treated with crossed pinning (Lyons et al 1998). In addition, radial pinning may damage the radial and anterior interosseous nerve (Brauer et al 2007, Kocher et al 2007, Omid et al 2008).…”

mentioning

confidence: 99%

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

Eberl¹,

Eder²,

Smolle³

et al. 2011

Acta Orthopaedica

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Background and purposeUlnar nerve injury may occur after pinning of supracondylar fractures in children. We describe the outcome and compare the rates of iatrogenic injuries to the ulnar nerve in a consecutive series of displaced supracondylar humeral fractures in children treated with either crossed pinning or antegrade nailing.MethodsMedical charts of all children sustaining this fracture treated at our department between 1994 and 2009 were retrospectively reviewed regarding the mode of treatment, demographic data including age and sex, the time until implant removal, the outcome, and the rate of ulnar nerve injuries.Results503 children (55% boys) with an average age of 6.5 years sustained a type-II, type-III, or type-IV supracondylar fracture. Of those, 440 children were included in the study. Antegrade nailing was performed in 264 (60%) of the children, and the others were treated with crossed pins. Iatrogenic ulnar nerve injury occurred in 0.4% of the children treated with antegrade nailing and in 15% of the children treated with crossed pinning. After median 3 (1.6–12) years of follow-up, the clinical outcome was good and similar between the 2 groups.InterpretationIntramedullary antegrade nailing of displaced supracondylar humeral fractures can be considered an adequate and safe alternative to the widely performed crossed K-wire fixation. The risk of iatrogenic nerve injury after antegrade nailing is small compared to that after crossed pinning.

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Cited by 72 publications

References 7 publications

Lateral Entry Fixation Using Three Divergent Pins for Displaced Paediatric Supracondylar Humeral Fractures

Lateral Entry Fixation Using Three Divergent Pins for Displaced Paediatric Supracondylar Humeral Fractures

Ulnar nerve injury after a comminuted fracture of the humeral shaft from a high-velocity accident: a case report

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

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