How should one treat iatrogenic ulnar injury after closed reduction and percutaneous pinning of paediatric supracondylar humeral fractures?

The purpose of this study was to compare primarily open versus primarily closed surgical treatment of Gartland type III extension supracondylar fractures in children. Also the outcomes of different pinning techniques in open surgery were evaluated retrospectively. Eighty displaced type III extension supracondylar fractures treated consecutively at two different centres were included. The treatment protocol of one institute was primarily closed reduction and percutaneous cross-pinning (n=43). The treatment protocol of the other institute was primarily open reduction and internal fixation (n=37) with two lateral parallel pins (n=11), cross pins (n=11) and two lateral and one medial pin (n=15) according to the stability and configuration of the fracture. According to Flynn's criteria the outcomes of the open and closed reduction groups were not statistically significant (P>0.05). Although the outcomes of closed reduction showed no superiority over open reduction, it should be the first choice of treatment due to its low morbidity and short hospital stay.

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“…Kalanderer et al have reported that ulnar nerve palsies which developed after surgery mostly recover spontaneously without complication [7,10].…”

Section: Discussionmentioning

confidence: 99%

Operative management of type III extension supracondylar fractures in children

Kazımoğlu

Çetin

Şener

et al. 2008

International Orthopaedics (SICOT)

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“…However, there has always been a difference of opinion for better method of fixation between cross medial-lateral k wiring and parallel lateral k wire fixation [4] . Hence, outcomes and complications like deformity due to loss of reduction and rate of iatrogenic ulnar nerve palsy help us define a better method of fixation [5,6] . The advantage of medial-lateral entry pin fixation is probably increased biomechanical stability, although iatrogenic ulnar nerve injury may result from placement of the medial pin [2,4,7] .…”

Section: Supracondylar Humerus Fractures (mentioning

confidence: 99%

A comparative study of two percutaneous pinning techniques (Cross K wire vs Lateral K wire) for Gartland type III pediatric supracondylar fracture of the humerus

Patil¹,

Gaonkar²,

Pandey³

et al. 2017

Int. J. Orthop. Sci.

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Background: Supracondylar fractures of humerus are one of the most common fractures in paediatric age group. Closed reduction and percutaneous K-wire fixation is one of the most commonly used treatment modality in Gartland type 3 fractures. A prospective randomized controlled study was undertaken to compare whether parallel k wires are better in terms of the stability, functional outcome and iatrogenic ulnar nerve as compared to cross k wire (medial and lateral). Material and methods: This is a prospective comparative randomized controlled trial. A total of 30 patients of displaced supracondylar fracture aged between 5-13 years, without any compound injury or comminution were enrolled for the study and randomly divided into two groups, each of 15 patients. One group was assigned treatment of crossed pinning and other group with lateral pinning respectively and outcome was evaluated on basis of pain, motion, stability and function according to Mayo's elbow score and follow-up was maintained for a period of 45 days and statistical significance was calculated. Results: After assessment of 15 patients in each group we found out that mean mayo score was 98 in cross pinning group and 96.83 in lateral pinning group. This difference is statistically not significant. Conclusion: In our study we conclude that, lateral pinning is an equally good treatment choice in these fractures and especially for grossly swollen elbows. Also, risk of ulnar nerve injury during placement of medial pin is eliminated in lateral parallel k wires. Both the methods offer consistently satisfactory functional and cosmetic results.

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“…The incidence of reported iatrogenic ulnar nerve lesions with a medial pin ranges from 1.4% to 15.6% (16,(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis was (a) benign in most cases and observation was the appropriate management; with full recovery within months (they were most likely neuropraxia or axonotmesis (Sunderland type 1 and 2) however, (b) permanent damage has been reported in the literature in a few cases,. Therefore, where the medial pin appears to have a position in the ulnar notch, it may be appropriate either to remove that pin and replace it with another in a more anterior position, or to perform early exploration (2,16,(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Three Percutaneous Pinning Techniques for Paediatric Supracondylar Humeral Fractures

2017

ARC Journal of Orthopedics

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How should one treat iatrogenic ulnar injury after closed reduction and percutaneous pinning of paediatric supracondylar humeral fractures?

Cited by 46 publications

References 23 publications

Operative management of type III extension supracondylar fractures in children

Operative management of type III extension supracondylar fractures in children

A comparative study of two percutaneous pinning techniques (Cross K wire vs Lateral K wire) for Gartland type III pediatric supracondylar fracture of the humerus

A Comparative Study of Three Percutaneous Pinning Techniques for Paediatric Supracondylar Humeral Fractures

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