Risk of ulnar nerve injury during cross-pinning in supine and prone position for supracondylar humeral fractures in children: a recent literature review

@article{Catena2019RiskOU,
  title={Risk of ulnar nerve injury during cross-pinning in supine and prone position for supracondylar humeral fractures in children: a recent literature review},
  author={Nunzio Catena and Maria Grazia Calevo and Dario Fracassetti and D{\'e}sir{\'e}e Moharamzadeh and C. Origo and Maurizio De Pellegrin},
  journal={European Journal of Orthopaedic Surgery \& Traumatology},
  year={2019},
  volume={29},
  pages={1169-1175}
}
Aim of this review article is to evaluate the percentage of ulnar nerve lesion during cross-pinning considering the patient’s position (supine or prone) on the surgical bed. Comprehensive research was performed by searching in PUBMED, Cochrane Library, ISI Web of Science, SCOPUS and Clinicaltrials.gov from 2005. Children with extension type supracondylar humeral fractures without clinical signs of ulnar nerve lesion at presentation were included. A total of 28 papers were examined including… 
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12 Citations
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12 Citations

Is Supine Position Superior to Prone Position in the Surgical Pinning of Supracondylar Humerus Fracture in Children?
TLDR
Both supine and prone positioning achieved a satisfying outcome with similar results in joint function recovery and complications, comparing two different intra-operative positionings.
COMPARISON OF TREATMENT OUTCOMES OF SUPRACONDYLAR FRACTURES OF HUMERUS BY LATERAL ENTRY K WIRES VERSUS CROSS K WIRES IN CHILDREN
TLDR
Lateral fixation with wire k is as effective as cross k-wire in the treatment of displaced supracondylar fracture of the humerus in children who maintain the technical aspect of fracture reduction.
Extraphyseal distal radius fracture in children: is the cast always needed? A retrospective analysis comparing Epibloc system and K-wire pinning
TLDR
Functional recovery is faster, and postoperative physiotherapy is rarely required with ES, which allows this device to go beyond the traditional concept of mandatory postoperative immobilization after pediatric wrist fractures surgery.
Independent predictors affecting the reduction of pediatric supracondylar humerus fractures: a retrospective cohort study
TLDR
Obesity was an independent predictor of both prolonged operative time and malrotation, a finding that has not been previously reported.
Humerus trochlear angle (HTa)—a possible alternative for Baumann angle in the reduction of supracondylar humerus fractures
TLDR
HTa may be a convenient and reliable parameter that could guide the reduction of supracondylar humerus fractures, especially for young children, and was associated with shorter operation time and less radiation exposure in this investigation.
MANAGEMENT OF SUPRACONDYLAR FRACTURE OF HUMERUS USING CROSSED LATERAL PINNING
TLDR
Near manipulation and percutaneous attachment in the paediatric age group is an appropriate and conclusive treatment procedure with two crossing-lateral K wire of Gartland type II and III supracondylar fractures with less complications.
Elastic Stable Intramedullary Fixation Using Epibloc versus Crossed Kirschner Wires Fixation for Distal Forearm Fractures in Children: A Retrospective Analysis
TLDR
Epibloc system applied with a minimal technical variation is safe and effective in treating distal ulna and radius fractures, with minimal requirement of post-surgical rehabilitation.
Current concepts in diagnosis and management of common upper limb nerve injuries in children
TLDR
The aim of the article is to analyse the main aspects of the different closed PNI of the upper limb in order to provide recommendations for timely and correct management, and to determine differences in the PNI treatment between children and adults.
Current trends in the treatment of supracondylar fractures of the humerus in children: Results of a survey of the members of European Paediatric Orthopaedic Society
TLDR
European Paediatric Orthopaedic Society members agreed on the treatment modality of Gartland type II and III supracondylar humerus fractures, patient positioning, and timing of hardware removal, but other important issues such as timing of surgery, pins configuration, surgical approach, and post-operative protocol are still debated.
The most commonly injured nerves at surgery: A comprehensive review
TLDR
Although the root cause of iatrogenic nerve injury differs for each nerve, there are four unifying factors that could potentially decrease this risk for all peripheral nerves.
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TLDR
There was no significant difference in the ease of reduction and pinning between supine and prone positions and Supine position is ideal for closed reduction andPinning of all patterns of type III supracondylar fractures.
Low Incidence of Ulnar Nerve Injury With Crossed Pin Placement for Pediatric Supracondylar Humerus Fractures Using a Mini-Open Technique
TLDR
The rate of iatrogenic ulnar nerve injury with this specific technique of crossed pin placement for extension-type supracondylar humerus fractures was extremely low in this series.
Prospective, surgeon-randomized evaluation of crossed pins versus lateral pins for unstable supracondylar humerus fractures in children
TLDR
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TLDR
Percutaneous crossed K-wire pinning after closed manipulation in supracondylar extension type III fracture of the humerus is a reliable and safe method of treatment and is recommended in all.
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TLDR
It was concluded that, anteroposterior insertion of the medial pin in the saggital plane, while the elbow was in hyperflexion, correlated with the occurrence of iatrogenic ulnar nerve injury.
Supracondylar extension type III fracture of the humerus in children: percutaneous cross-pinning.
TLDR
Percutaneous crossed K-wire pinning after closed manipulation in supracondylar extension type III fracture of the humerus is a reliable and safe method of treatment and is recommended in all.
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TLDR
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Medial and Lateral Pin Versus Lateral-Entry Pin Fixation for Type 3 Supracondylar Fractures in Children: A Prospective, Surgeon-Randomized Study
TLDR
There was no statistical difference in the radiographic outcomes between lateral-entry and medial and lateral-pin techniques for the management of Type 3 supracondylar fractures in children when evaluated in this prospective and surgeon-randomized trial, but 2 cases of iatrogenic injured nerve occurred with medially placed pins.
How should one treat iatrogenic ulnar injury after closed reduction and percutaneous pinning of paediatric supracondylar humeral fractures?
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