Ulnar Nerve Monitoring During Percutaneous Pinning of Supracondylar Fractures in Children

Shtarker, Haim; Elboim-Gabyzon, Michal; Bathish, Einal; Laufer, Yochy; Rahamimov, Nimrod; Volpin, Gershon

doi:10.1097/bpo.0000000000000084

Cited by 19 publications

(19 citation statements)

References 21 publications

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“…74 Ulnar nerve location by palpation only is not a totally safe technique. 75 Other techniques such as intra-operative electrical stimulation 76 or ultrasound monitoring 77 have been proposed as safe but technically demanding methods to avoid ulnar nerve injuries.…”

Section: Surgical Techniquementioning

confidence: 99%

Management of supracondylar fractures of the humerus in children

2018

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Supracondylar fractures of the humerus are the most frequent fractures of the paediatric elbow, with a peak incidence at the ages of five to eight years.Extension-type fractures represent 97% to 99% of cases. Posteromedial displacement of the distal fragment is the most frequent; however, the radial and median nerves are equally affected. Flexion-type fractures are more commonly associated with ulnar nerve injuries.Concomitant upper-limb fractures should always be excluded. To manage the vascular status, distal pulse and hand perfusion should be monitored. Compartment syndrome should always be borne in mind, especially when skin puckering, severe ecchymosis/swelling, vascular alterations or concomitant forearm fractures are present.Gartland’s classification shows high intra- and inter-observer reliability. Type I is treated with casting. Surgical treatment is the standard for almost all displaced fractures. Type IV fractures can only be diagnosed intra-operatively.Closed reduction and percutaneous pinning is the gold standard surgical treatment. Open reduction via the anterior approach is indicated for open fractures, absence of the distal vascular flow for > 10 to 15 minutes after closed reduction, and failed closed reduction.Lateral entry pins provide stable fixation, avoiding the risk of iatrogenic ulnar nerve injury.About 10% to 20% of displaced supracondylar fractures present with alterations in vascular status. In most cases, fracture reduction restores perfusion.Neural injuries occur in 6.5% to 19% of cases involving displaced fractures. Most of them are neurapraxias and it is not routinely indicated to explore the nerve surgically.Cite this article: EFORT Open Rev 2018;3:526-540. DOI: 10.1302/2058-5241.3.170049

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Section: Surgical Techniquementioning

confidence: 99%

Management of supracondylar fractures of the humerus in children

2018

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“…However, there is slightly probability of radial or anterior interosseous nerve damage associated with lateral pin fixation (Sibinski et al 2006 ; Brauer et al 2007 ). Different surgical techniques were used to prevent iatrogenic ulnar nerve injury (Sibinski et al 2006 ; Bashyal et al 2009 ; Brauer et al 2007 ; Eidelman et al 2007 ; Shim and Lee 2002 ; Skaggs et al 2001 ; Michael and Stanislas 1996 ; Gordon et al 2001 ; Wind et al 2002 ; Shtarker et al 2014 ). However, these techniques do not completely prevent ulnar nerve injuries (Brauer et al 2007 ; Skaggs et al 2001 ; Wind et al 2002 ).…”

Section: Discussionmentioning

confidence: 99%

The outcome and parents-based cosmetic satisfaction following fixation of paediatric supracondylar humerus fractures treated by closed method with or without small medial incision

et al. 2016

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Supracondylar humerus fractures are common in children. Displaced fractures are usually treated with closed reduction and cross pin fixation. But, medial pinning may cause the ulnar nerve injury. The aim of this study was to compare the parents-based cosmetic satisfaction of the incision scars in children with displaced supracondylar humerus fractures treated by closed reduction and cross pin fixation with or without small medial incision. We retrospectively reviewed the medical records of 72 children with displaced supracondylar humerus fractures treated two different closed reduction and percutaneous pinning methods at our institution from January 2010 through December 2013. A group has 36 patients treated with small medial incision and crossed K-wires fixation after closed reduction. The other group has 36 patients treated with closed reduction and K-wires fixation. At the final follow-up, the patients were evaluated radiologically and clinically with Flynn’s criteria. Furthermore, a visual analogue scale was used to determine of the parents-based cosmetic satisfaction score. All fractures healed without major complications at the final clinical and radiological assessment. Although, between the two groups did not differ in terms of Flynn cosmetic and functional outcomes, there were statistically significant differences between both groups according to the parents-based cosmetic satisfaction scores. The closed reduction and crossed pin fixation without small medial incision should be preferred first because of better the parents-based cosmetic satisfaction.

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“…[19] Lyons et al [20] and Kalenderer et al [21] reported 5% and 5.2% iatrogenic ulnar nerve injuries in 375 and 473 patients, respectively. Iobst et al [7] reported nerve injuries in 20 patients (6.6%) they treated with semi-sterile technique.…”

Section: Discussionmentioning

confidence: 99%

“…It is the opinion of the authors that this could be minimalized if mini-open technique described by Green et al [22] is used, but it is inappropriate to use this technique in semi-sterile conditions. Shtarker et al [19] used ulnar nerve monitoring to avoid iatrogenic nerve injury for medial pin insertion and stated that there were no iatrogenic ulnar nerve injuries in 138 patients. Similarly, nerve monitoring is not appropriate for semi-sterile conditions.…”

Section: Discussionmentioning

confidence: 99%