Ultrasound-Guided Lateral Crossed-Pin Fixation in Pediatric Supracondylar Humerus Fractures

Abstract

Background: Closed reduction and pinning is the gold standard in the treatment of displaced pediatric supracondylar humerus fractures. With different methods of pinning available, iatrogenic nerve damage is one of the most common complications of this technique. In our study, we aimed to test the preventability of radial nerve injury in the ultrasound-guided lateral cross pinning technique. Methods: The study included 30 patients who were admitted to our clinic between September 2019 and September 2020 due to supracondylar humerus fractures and underwent closed reduction with the lateral cross pinning technique under ultrasonography. Demographic and clinical data of the patients including age, gender, fracture type and side, arm diameters of the fractured and contralateral sides, the distance between the lateral condyle and the radial nerve (LCRN), the distance between the proximal K-wire and the radial nerve (PWRN), duration of surgery, and postoperative complications of the nerve were retrieved from the patient files and recorded. Results: Fifteen (50%) of the 30 patients included in the study were girls. The patients’ mean age was 59.2±33.9 months. While 3.3% of the patients had flexion-type injuries, 30.0% had Gartland Type 2, 40.0% had Type 3, and 26.7% had Type 4 injuries. Eighteen patients (60%) had fractures in their left extremities. Type 4 fractures exhibited the biggest difference among all fracture types in comparison of the arm diameters of the fractured and contralateral sides (17.1%±5.5%; p=0.013). In the comparison of the PWRN to LCRN distance ratio, the difference was the highest in Type 2 fractures (23.3%±8.0%; p=0.027). None of the patients encountered postoperative iatrogenic radial nerve injury. Conclusion: In pediatric patients with supracondylar humerus fractures, the swelling of the extremity increases with the severity of the fracture. This situation decreases inversely with the distance of the proximal K wire from the radial nerve. The ultrasound-guided lateral cross pinning technique is a reliable method in terms of ease of application and the determination of the nerve line to create a safe zone, especially in elbow injuries with excessive swelling.