Iatrogenic ulnar nerve injury after percutaneous pinning of displaced supracondylar fractures of the humerus

ABSTRACT

To assess iatrogenic ulnar nerve injuries after supracondylar humeral fractures treated with closed reduction and percutaneous pinning. Descriptive case series. Orthopedic and Trauma Department of Postgraduate Medical Institute, Hayatabad Medical Complex Peshawar, from December 2007 to December 2010 Children between 1-12 years of age and extension-type displaced supracondylar fracture of humerus were included. Neurovascular status was assessed before operation. Closed reduction was performed under general anesthesia and confirmed with the image intensifier, followed by pinning. After surgery, a long arm back slab was applied. After the procedure, neurovascular status assessed again. The pins were removed at a mean of 5 weeks [4-6 weeks] postoperatively. The neurological complications were assessed both for sensory loss and motor loss. Clinical and electro-myographic examinations were performed at 6 and 12 weeks postoperatively in patient with ulnar nerve lesions. Eighty two patients presented during the study period. There were 62.2% [n 51] males and 37.8% [n 31] females. Left humerus was involved in 69.5% [n 57] cases. The mean age was 6.61 +/- 2.25 years. A total of three [3.7%] iatrogenic ulnar nerve injuries occurred in these patients. Electromyogram showed partial denervation and conduction blocks at the elbow at 6 weeks. Regenerative electromyogram findings were seen at 12 weeks. Sensory and motor functions in all patients returned at a mean of 8 +/- 2.34 weeks and 22 +/- 4.87 weeks respectively. In all patients nerve function returned completely. Iatrogenic ulnar nerve injury is a common complication of percutaneous pinning in displaced supracondylar fracture of humerus in children but usually it resolves spontaneously