The authors compared two techniques for safe medial pin placement during fixation of supracondylar humeral fractures, namely closed pinning and mini-open pinning of medial wire insertion, and their effectiveness in protection against iatrogenic ulnar nerve injury.
One hundred and nineteen patients with type 2 and 3 Gartland supracondylar humeral fractures (AO Foundation/Orthopaedic Trauma Association [AO/OTA] 13-M/3.1 II, III and IV) were included in this study after applying the exclusion criteria. All patients were managed with cross pinning with identification of two groups. The first group was for percutaneous pinning (N=63), and the second group for patients with medial open incision during medial wire insertion (N=56). All patients were evaluated for the incidence of nerve injury after surgery.
Nerve injury occurred in 12 of 119 patients. The estimated duration of follow-up was 43.6±10.2 wk. The results revealed nine patients who had ulnar nerve injury among both groups (group 1, N=8, group 2, N=1), with statistically better results in group 2 (P=0.02). The incidence of nerve injury was not found to be correlated with other variables, which included age, gender, type of fracture, number of Kirschner wires that were inserted, and the level of the surgeon.
A medial mini-open incision decreased the risk of ulnar nerve injury during cross pin fixation in the treatment of displaced supracondylar humeral fractures, without additional morbidity.
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