Explainable and evidence-linked recommendations for spine surgery via a retrieval-augmented LLM agent.

Comparisons made between spine-trained neurosurgeons (Neuro) and orthopaedic surgeons (Ortho) can be a delicate matter. Considering most authors are spine surgeons, one may wonder if study results inappropriately favor authors' own specialties. The purpose of this study was to perform a bibliometric analysis of all studies comparing spine surgeons of each training pathway and to evaluate potential biases when reporting study results. A systematic review was conducted according to the PRISMA statement. All literature comparing Neuro and Ortho before May 2022 were identified. Included articles were categorized according to the training backgrounds of the first and last authors ("Neuro-Neuro," "Ortho-Ortho," or "Author Diverse"), evaluated for inclusion of both Neuro and Ortho authors from the total author list, and classified by journal type of publication ("Neuro Journal," "Ortho Journal," or "Combined Journal"). A Neuro and Ortho spine surgeon each independently reviewed a subset of articles evaluating postoperative outcomes, categorizing the articles' stated conclusions (Pro-Neuro, Pro-Ortho, Neutral). Student t -test and Chi-squared analyses were used when appropriate to test for significance. Alpha level was set at <0.05. A total of 80 studies were identified. Overall, 26 Neuro-Neuro articles, 34 Ortho-Ortho articles, and 20 Author Diverse articles were included. Neuro-Neuro authors were found to publish more in Neuro Journals ( P < 0.001). No differences were observed for inclusion of both Neuro and Ortho authors between studies published by the three different author types. Overall, there were 22 articles comparing postoperative outcomes: 15 articles (68%) reported no notable differences, whereas 3 (14%) found improved outcomes with Neuro, and 4 (18%) found improved outcomes with Ortho. No notable differences were found in outcomes when analyzed according to author type ( P = 0.531), journal type ( P = 0.962), and database used ( P = 0.636). The growing body of literature comparing Neuro and Ortho spine surgeons shows little differences in surgical outcomes and no evidence of bias. V.

Ceramic-on-ceramic bearings are widely used in total hip arthroplasty (THA); although rare, ceramic femoral head fracture represents a serious complication. This event typically occurs early or after trauma, whereas atraumatic late-onset fractures confined to the femoral head component are exceedingly uncommon. A 73-year-old patient developed sudden-onset hip pain and functional impairment 11 years after a primary ceramic-on-ceramic THA. The patient denied any preceding trauma. Radiographs demonstrated multiple ceramic fragments without clear identification of the donor site; intraoperative inspection confirmed a fractured femoral head with an intact liner. Revision surgery was performed with complete removal of ceramic debris and exchange to a new ceramic femoral head using a taper adapter while preserving the well-fixed stem. The postoperative course was uneventful, and the patient regained satisfactory function at follow-up. This case represents an exceedingly rare late atraumatic fragmentation of a ceramic femoral head in a ceramic-on-ceramic THA, with successful stem-preserving revision despite extensive intra-articular ceramic debris. Orthopedic surgeons and musculoskeletal radiologists should remain vigilant for this possibility in patients presenting with acute hip symptoms years after implantation. Prompt recognition and revision surgery are essential to achieve favorable outcomes.

Study DesignRetrospective cohort study.ObjectiveTo comprehensively evaluate the clinical and radiological characteristics across intramedullary increased signal intensity (ISI) grades (Grade 0, 1, and 2) on T2-weighted magnetic resonance imaging (MRI) and identify preoperative predictors of ISI severity as well as risk factors for poor postoperative recovery in patients with thoracic ossification of the ligamentum flavum (T-OLF).MethodsA total of 148 patients who underwent posterior laminectomy surgery for T-OLF between January 2017 and August 2023 was retrospectively analyzed. Demographic, imaging, surgical, and clinical outcome data were collected. ISI grades were independently assessed by three blinded spinal surgeons. Univariate and multivariate logistic regression analyses were performed to identify independent predictors and risk factors.ResultsHigher ISI grades were associated with worse preoperative neurological status, greater spinal canal compression, more complex OLF morphology, and increased intraoperative blood loss. Multivariate analysis identified a high canal occupying ratio (COR) (Odds ratio [OR] = 3.20, P = .012) and beak-type configuration on sagittal MRI (OR = 4.24, P = .003) as independent predictors of higher ISI grades. Moreover, multi-segment OLF (OR = 2.23, P = .028) and ISI Grade 2 (OR = 3.67, P = .044) independently predicted poor postoperative recovery.ConclusionPreoperative ISI grade serves as a critical prognostic indicator in T-OLF. High COR and beak-type configuration on sagittal MRI predict severe ISI grades, whereas multi-segment OLF and ISI Grade 2 independently predict poor postoperative outcomes. Incorporating these parameters into preoperative assessment may improve risk stratification, patient counseling, and surgical planning.

In the evolving healthcare landscape, orthopaedic surgeons are increasingly required to demonstrate not only clinical excellence but also strategic thinking, leadership, and financial literacy. This review explores the intersection of business principles and surgical practice, highlighting foundational concepts frequently taught in MBA programs: project management, value proposition, the time value of money, cost accounting, and operations management. This article presents an evidence-based discussion on how these principles can enhance surgical efficiency, as well as long-term financial and career planning.

Supracondylar humerus fractures (SHFs) are the most common type of elbow fracture in children, typically resulting from a fall onto an outstretched hand. Accurate and timely diagnosis is critical to avoid severe complications such as neurovascular injury, compartment syndrome, and malunion. To support the automated and precise diagnosis of pediatric SHFs, we present PediaSHF-DX, a high-quality benchmark dataset comprising 10,325 de-identified elbow X-ray images from 5,163 pediatric patients. Among them, 2,015 images were carefully annotated by two experienced orthopedic surgeons using a double-blind, cross-review protocol to ensure labeling accuracy and clinical reliability. We propose an improved YOLOv11-based detection model that incorporates a LocalAttention-enhanced Bottleneck module and an optimized transmission structure to enhance small-fracture sensitivity and improve fine-grained feature extraction. The model demonstrates high performance on a separate test set of 8,310 images, achieving a precision of 0.96 and showing strong generalization and robustness across various imaging conditions. PediaSHF-DX is publicly available on Figshare and serves as a valuable resource for developing AI-driven diagnostic tools for pediatric orthopedic care.

General anesthesia (GA) has long been the preferred modality of anesthesia for spine surgery, including transforaminal lumbar interbody fusions (TLIFs). However, recent advances in regional anesthesia, including spinal (awake) anesthesia and regional blocks, have demonstrated potential improvements in both surgical outputs and recovery times compared with GA. This study aims to describe the associations between regional anesthesia, clinical outcomes, and opioid utilization among patients undergoing TLIF. The electronic medical records of a single fellowship-trained spine surgeon were analyzed retrospectively, and patients undergoing a single-level TLIF between 2018 and 2024 were included. Pre- and postoperative clinical measures (eg, length of stay, operating time, and readmission rates) and both intra- and postoperative opioid use were collected. All data were analyzed using a multivariable regression model. Compared with GA, awake anesthesia was associated with reduced intraoperative opioid utilization (P = 0.007) across all TLIF groups, while the use of an erector spinae plane (ESP) block was associated with a reduced length of stay (P = 0.044) and lower postoperative opioid utilization (P < 0.001). The use of spinal anesthesia combined with the use of an ESP block was associated with significantly lower length of stay and lower postoperative morphine equivalent daily dose (P = 0.030 and P = 0.002, respectively). Awake TLIF surgery under spinal anesthesia and the use of an ESP block were independently associated with reduced opioid usage, while the combined use of these techniques was associated with decreased length of stay and reduced postoperative opioid usage. Additional investigation and prospective studies are needed to further elucidate these complex relationships. The relationship between regional anesthesia and patient outcomes has not been comprehensively characterized in the TLIF patient population despite the growing utilization of these techniques in spine surgery. Once established, these findings have potential implications for the integration of regional anesthesia into TLIF procedures as a new standard of care. Preliminary evidence suggests that regional anesthesia offers multiple benefits over GA, including health and mortality outcomes, time to ambulation and recovery, and incidence of postoperative complications. However, little is known about the applicability of these findings to patients undergoing TLIF.

The thrower's oblique rotator cuff (TORC) view was developed to more optimally visualize the commonly injured posterosuperior rotator cuff and capsulolabral structures in overhead athletes. The purpose is to evaluate whether the addition of the TORC view to standard MRI sequences improves the diagnostic evaluation of rotator cuff pathology and labral abnormalities in throwing athletes. Shoulder MRIs of MLB pitchers ordered by team physicians from 1/1/2019 to 12/31/2021 were retrospectively reviewed. The inclusion criteria were standard and TORC MRI sequences per individual player and players aged 18-35. The MRIs were read by a musculoskeletal radiologist and two orthopedic surgeons with and without the addition of the TORC plane. The TORC view resulted in minor redistribution of supraspinatus, infraspinatus, and labral classifications. Signal size measurements differed significantly between standard and TORC views at the individual reader level (p = 0.042, p = 0.003, and p < 0.001), with generally larger measurements on the TORC view; however, no significant difference was observed when measurements were pooled across readers (median 17.0mm; p = 0.197). Inter-reader reliability for signal size improved with the TORC view (ICC 0.47 → 0.73). Overall diagnostic confidence increased significantly for two of three readers with the TORC view (median paired increase, 1.0 point; p < 0.001), while no significant change was observed for the third reader. The addition of the TORC plane was associated with improved reader confidence and inter-reader reliability for quantitative signal size assessment without introducing systematic changes in categorical tendon or labral classification. These findings support the use of the TORC sequence as an adjunct to standard shoulder MRI protocols to enhance interpretive consistency and confidence, particularly in elite overhead throwing athletes.

Study DesignNarrative Review.ObjectivesBone health optimization before spine surgery is an important but overlooked determinant of long-term postoperative outcomes. Compromised bone quality is associated with hardware loosening, pseudoarthrosis, proximal junctional failure, and revision surgery. This narrative review aims to highlight the importance of preoperative bone optimization and propose a pragmatic clinical pathway for spine surgeons. Specifically, we aimed to: (1) outline risk assessment and diagnostic strategies, including clinical risk factors, laboratory testing, and imaging such as dual-energy x-ray absorptiometry (DEXA) and opportunistic CT-based Hounsfield Unit (HU) analysis; (2) evaluate therapeutic options, emphasizing pharmacologic agents (teriparatide, romosozumab, denosumab, and bisphosphonates) alongside non-pharmacologic measures including nutrition and lifestyle modification; and (3) explore future directions, including therapy duration and economic barriers to wider adoption of newer agents.MethodsThis narrative review synthesizes the current literature on preoperative bone health management in spine surgery. Risk assessment strategies were discussed including imaging, laboratory testing, and clinical picture analysis. Therapeutic options evaluated emphasize pharmacologic agents alongside non-pharmacologic measures.ResultsDespite the clinical relevance of compromised bone quality to poor surgical outcomes, bone health assessment remains inconsistently incorporated into surgical planning. Current evidence supports a multimodal approach combining targeted assessment and timely intervention to mitigate risk of adverse bone-related events following spine surgery.ConclusionsPreoperative bone health optimization is a crucial opportunity to improve long-term outcomes for patients undergoing spine surgery. Adoption of a standardized clinical pathway for risk stratification, diagnosis, and treatment may provide a valuable framework for improving fixation stability and fusion rates.

National cross-sectional survey. Hospitals delivering orthopaedic and trauma services across all levels of care and ownership categories in Tanzania. Licensed orthopaedic and trauma surgeons practising in Tanzania served as key informants for their respective hospitals. A total of 171 surgeons provided data on 92 unique hospitals nationwide. Primary outcomes included orthopaedic departmental structural capacity, availability of multidisciplinary specialist support, external support mechanisms and in-hospital orthopaedic training activities. A response rate of 77.7% yielded data on 92 hospitals delivering orthopaedic and trauma services nationwide. Structural capacity varied widely, with only 19.6% of hospitals reporting more than 50 orthopaedic beds, 43.5% relying on a single orthopaedic surgeon, and 47.8% operating with one or two functional theatres. Access to specialist support was limited, with vascular trauma surgeons available in 9.8% of hospitals and plastic and reconstructive surgeons in 8.7%. Intensivists were available in 41.3% of facilities and anaesthesiologists in 57.6%, while physiotherapists were present in 90.2% of hospitals but occupational therapists in only 28.3%. External dependence was common, with 41.3% of hospitals relying on donated implants and 29.3% participating in outreach programmes. In-hospital orthopaedic training opportunities were limited, with seminars or workshops available in 25.0% of hospitals. Across domains, higher-tier hospitals demonstrated significantly greater structural capacity and specialist availability. Orthopaedic and trauma services in Tanzania are available across multiple levels of the health system but are characterised by inequitable workforce distribution, limited capacity at lower-tier hospitals and substantial reliance on external assistance. Integrated strategies linking infrastructure development, multidisciplinary workforce expansion, sustainable procurement and decentralised training are essential to strengthen the organisation and resilience of orthopaedic and trauma services nationwide.

Objectives: To develop and validate a deep-learning model capable of detecting and quantifying intraoperative bleeding to objectively evaluate visual field impairment in unilateral biportal endoscopic spine surgery (UBE). Methods: Overall, 223,568 still images were extracted from 20 UBE videos and used to train a U-Net++ segmentation model based on the red masks generated using hue, saturation, and value (HSV) thresholding. The model was fine-tuned using 350 manually annotated images that differentiated clinically relevant bleeding (red masks) from non-bleeding red regions (zero masks). The model performance was evaluated against 180 ground-truth images annotated by three spine surgeons, which were extracted from videos that were separate from those used for training and fine-tuning. Dice and intersection-over-union (IoU) scores were calculated, and correlation analyses were performed based on inter-annotator agreement. Results: The HSV-based model reproduced the red regions with high fidelity; however, it showed limited agreement with the ground-truth bleeding regions (median Dice = 0.57, IoU = 0.40). The fine-tuned model improved substantially. For image-wise binary classification of bleeding presence, the model achieved an accuracy of 86%, with a sensitivity of 93% and a specificity of 60%. For pixel-level segmentation performance, the model achieved a median Dice score of 0.79 and a median IoU of 0.65 on ground-truth-positive images. Dice performance exceeded 0.80 in cases with strong inter-surgeon ground-truth concordance (≥0.80) and substantial bleeding area (>20%). Conclusions: This deep-learning model can accurately detect clinically meaningful intraoperative bleeding in UBE and quantify visual field impairments in still images and surgical videos. Future applications include the evaluation of hemostatic techniques, postoperative image-based assessment of surgical quality, and real-time intraoperative bleeding alerts to support surgical decision-making.

The World Health Organization (WHO) Surgical Safety Checklist (SSC) reduces peri-operative complications and mortality, yet its consistent adoption in low- and middle-income settings such as Nigeria may be limited by cultural, and training-related barriers. Objective: To evaluate awareness, use, and barriers to WHO SSC implementation amongst Nigerian orthopedic surgeons. Cross-sectional survey amongst Nigerian orthopedic surgeons. 13-item electronic questionnaire assessing WHO SSC awareness, usage patterns, administration, perceived barriers, and SSC related education. Associations between professional grade and SSC compliance were examined using Fisher-Freeman-Halton exact testing. Binary logistic regression was performed to explore predictors of SSC noncompliance, reporting odds ratios with 95% confidence intervals. Thirty surgeons responded, (consultants 70.0%, senior registrars 20.0%, and registrars 10.0%). SSC awareness was 96.67%, with 90.0% reporting routine usage. Time constraints were associated with lower odds of compliance, but this did not reach conventional statistical significance (OR 0.128; 95% CI 0.012-1.311; P=0.083). Departmental resistance and insufficient training, although frequently reported, were not statistically significant predictors. Qualitative feedback highlighted persistent cultural and workflow related challenges. Checklist administration was predominantly nurse-led (73.33%), raising questions about shared responsibility. Despite high usage rates, barriers such as inadequate training (36.7%) and departmental resistance (20%) remain prevalent. WHO SSC awareness and reported routine use were high among Nigerian orthopedic surgeons; however, time pressure and persistent educational and cultural barriers may limit consistent adherence. Targeted curriculum integration, workflow optimization, interprofessional training, and continuous quality improvement may strengthen SSC implementation and surgical safety culture.

This study aimed to preliminarily explore the current application status and potential value of digital twin technology (DTT) that integrates artificial intelligence (AI) and medical imaging recognition in orthopedic surgical simulation education for bone tumors, and to analyze its effectiveness in surgical planning, biomechanical analysis, postoperative management, and training, through a systematic review conducted in accordance with PRISMA guidelines. Through a short of relevant literature, the progress in the application of AI-enhanced digital twins in bone tumor orthopedic surgery in recent years is analyzed. A structured literature search and review method was adopted, searching databases such as PubMed, Web of Science, and Scopus for literature published between 2015 and 2024. The inclusion criteria were studies involving orthopedic medical students or surgeons, with content related to the integration of DTT with AI and image recognition technologies applied to surgical planning, biomechanical analysis, postoperative management, and training. The results indicate that DTT, by combining AI-driven image analysis and biomechanical modeling with high-precision three-dimensional modeling and scenario simulation, significantly improves the accuracy of surgical planning, the precision of biomechanical analysis, and the scientific rigor of postoperative management. In training, the integration of DTT with virtual reality technology and AI-based simulation engines provides students and novice surgeons with a high-fidelity virtual surgical environment, significantly enhancing their operational skills and confidence. Although most current studies are small-scale experiments, the potential of AI-enhanced DTT in orthopedic medicine has been validated. In the future, with further integration of artificial intelligence, image recognition, and biomechanical simulation technologies, “personalized scenario generation” can be achieved, and a standardized scenario library for bone tumor surgical education can be established. This brief review aimed to map the preliminary landscape of the technology's applications and explore its future potential. Its findings were expected to help address the scarcity of bone tumor cases and the uneven distribution of training resources, thereby providing critical technological support for the standardized education and remote skill training in bone tumor surgery.

The management of midshaft clavicle fractures varies depending on fracture characteristics, patient demographics, and surgeon preferences. However, global differences in practice patterns and surgical decision-making for this injury remain poorly characterized. An international survey was conducted through Orthobullets between March 2021 and September 2024, targeting practicing orthopedic surgeons. Standardized polls, created collaboratively using the best available evidence and a peer-reviewed, evidence-based item list, were designed to capture global treatment preferences. Analyses were then performed to evaluate variation across subspecialties and practice environments. Multivariable regression was applied to examine associations between subspecialty, practice type, the likelihood of selecting operative management, and the preferred surgical techniques. The study included 2,364 surgeons from 76 countries. Overall, 46% (1,076 of 2,337 respondents) selected operative treatment, with notable regional differences. Surgeons from Asia (odds ratio [OR], 1.650), Africa (OR, 1.988), and Latin America (OR, 1.785) were more likely to choose surgery, whereas those from Oceania (OR, 0.464) were less likely. Trauma specialist were 1.45 times more likely to offer operative management. Regarding immobilization, 73.4% preferred a sling, while 23.4% chose a figure-of-eight brace. Among surgeons opting for surgery, 93% (1,479 of 1,590 respondents) selected open reduction and internal fixation with plates and screws. This study demonstrates a notable trend toward operative management of midshaft clavicle fractures, influenced by subspecialty and practice environment. These findings highlight the evolving landscape of fracture care and emphasize the need for standardized approaches and broader understanding across diverse healthcare systems.

Background/Objectives: The relationship between clinical volume and academic performance in orthopedic surgery remains understudied. The purpose of this study is to explore the characteristics of high-achieving academic orthopedic surgeons in an attempt to extrapolate patterns and trends that govern the relationship between clinical performance and academia in orthopedic surgery. Methods: The 2023 National Plan and Provider Enumeration System and Medicare claims data (2021-2022) databases were used to include all active orthopedic surgeons of different subspecialties. A publication score, based on publication volume, journal impact, and authorship position, was calculated for each included surgeon, and surgeons who scored in the top 5% were deemed high-achieving academic orthopedic surgeons. Additional data pertaining to demographic characteristics, clinical volume, relative value units (RVUs), and Healthgrades ratings were recorded and analyzed. Results: A total of 23,403 orthopedic surgeons were included in our study, with 1169 considered top researchers. There were significant disparities in multiple parameters according to gender. Moreover, there were geographic variations among orthopedic surgeons with regard to mean publication scores, clinical volume, and RVUs. The top researcher cohort had a higher mean publication score (p < 0.001) and a higher mean clinical volume (p < 0.001) when compared to the total surgeon cohort. Mean RVUs were higher in the total surgeon cohort, although not reaching significance. Hip and knee, as well as shoulder and elbow surgeons, had significantly greater clinical volumes in the top researcher cohort than in the total surgeon cohort (p < 0.001). Despite differences in clinical and research metrics, there were no significant differences in mean Healthgrades ratings and the mean number of Healthgrades ratings between the top researcher sample and the non-top researcher sample. Conclusions: Higher research productivity was not associated with lower clinical productivity, as high-achieving academic orthopedic surgeons demonstrated high academic performance while remaining clinically active.

Despite increasing awareness, women remain underrepresented in academic spine surgery. This study assessed whether women were equitably represented among spine surgeon PIs of clinical trials for degenerative spine disease research. This was a retrospective cohort study of spine surgeon principal investigators (PIs) in the United States (2015 to 2022). ClinicalTrials.gov was queried for the most common diagnoses and surgeries for degenerative spine diseases. Characteristics of spine surgeon PIs were collected from academic profiles. Participation-to-prevalence ratios (PPRs) were calculated for men and women PIs relative to their prevalence among spine surgery faculty at accredited training programs. A PPR of 0.8 to 1.2 indicated equitable sex representation. A PPR <0.8 was defined as underrepresentation and >1.2 as overrepresentation. In total, 129 spine surgeon PIs of 91 clinical trials were included in this study. Overall, there were 125 male (97%) and four female (3%) spine surgeon PIs. Overall, women were underrepresented among spine surgeon PIs (PPR = 0.64), whereas men had equitable representation (PPR = 1.02). From 2015 to 2018, female spine surgeons were underrepresented (PPR = 0.33), but achieved equitable representation from 2019 to 2022 (PPR = 0.95). Male spine surgeons had consistently equitable representation across the study period (PPR range 1.00 to 1.03). Women had equitable representation at assistant (PPR = 1.08) and associate (PPR = 0.31) professor ranks, but were underrepresented at the full professor rank (PPR = 0). PIs were funded by industry (54%), academic institution (44%), and US Federal (2%) sources. No differences were observed in funding sources by sex ( P = 0.36). There are a limited number of female spine surgeon PIs for degenerative spine disease clinical trials, which may have negative implications on the vitality of the specialty moving forward. Future investigations are needed to understand the barriers women face in obtaining clinical trial leadership positions.

As total ankle arthroplasty becomes an increasingly common treatment for end-stage ankle arthritis, managing failing implants is becoming a growing challenge for orthopaedic surgeons. The UK National Joint Registry reports a 13-year cumulative revision rate of 17.01% in patients aged under 65 years, and 3.22% in those aged over 75 years. These complex cases are challenging to manage and require a structured, multidisciplinary approach. Key factors influencing management include implant and hindfoot alignment, infection, bone stock, and implant stability. Recent advances in implant design, imaging methods, surgical planning, and revision techniques have expanded the armamentarium available to orthopaedic surgeons. This article aims to provide an overview of the algorithmic assessment and management of the failing ankle arthroplasty, highlighting the importance of thorough clinical evaluation, appropriate imaging, and early identification or exclusion of periprosthetic joint infection, along with tailored treatment strategies for each underlying pathology.

Adherence to developmental dysplasia of the hip screening guidelines among French healthcare providers: A cross-sectional survey.

Bot vs. doc-who is better at reading proximal humerus fracture x-rays?

Supracondylar humerus fracture is a common elbow injury sustained in the pediatric population. Percutaneous pinning, whether all lateral or medial-lateral, is the mainstay of operative management for these injuries. There has been much debate on the safety of medial-sided pinning, with the literature indicating that medial-sided pinning can lead to iatrogenic ulnar nerve injury. Thus, the goal of our study is to describe the rates of nerve injuries (radial, median, and ulnar), loss of reduction, and range of motion between all lateral and medial-lateral treatment groups. Patients aged 1 to 18 years presenting at a pediatric hospital for a single, isolated supracondylar humerus fracture and treated with percutaneous pinning between 2018 and 2023 were reviewed. Patients with concurrent surgical treatment at the time of pinning, who presented with multiple injuries, had an open reduction, had an open fracture, or were lost to follow-up, were excluded. Age, sex, Gartland fracture classification, pinning method, nerve injury, range of motion, loss of reduction, and duration of follow-up were collected. Descriptive statistics were analyzed for variables of interest. A total of 406 pediatric patients were included. The average (SD) age at presentation was 5.7 (2.3) years, with 179 (44.1%) patients presenting with Type II fracture and 227 (55.9%) with Type III or IV. There were 131 (32.3%) patients treated with a medial-lateral pinning approach and 275 (67.7%) patients treated with an all-lateral pinning approach. Patients treated with a medial-lateral pinning experienced no new ulnar, radial, or median nerve injuries postoperatively. There was 1 (0.8%) patient with a loss of reduction, and 68.4% of patients with a medial pin had a full range of motion at their last follow-up. Patients treated with an all-lateral pinning approach experienced a new median nerve injury (n=1) and a new ulnar nerve injury (n=1) postoperatively. No patients with an all-lateral pinning approach had a loss of reduction, and 70.7% had a full range of motion at the last follow-up. This study demonstrated no occurrence of an ulnar nerve injury while utilizing the medial entry pins in the treatment of supracondylar fractures. Strict adherence to surgical principles pertaining to medial entry pins is crucial to avoid ulnar nerve injury and should be included in orthopaedic surgeon's armamentarium when treating unstable supracondylar fractures.