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Iatrogenic Ulnar Nerve Injury After the Surgical Treatment of Displaced Supracondylar Fractures of the Humerus: Number Needed to Harm, A Systematic Review

Slobogean, Bronwyn L. PA-C*; Jackman, Heather MD, FRCSC; Tennant, Sally BSc, MBBS, FRCS (Tr & Orth); Slobogean, Gerard P. MD, MPH§; Mulpuri, Kishore MBBS, MS (Ortho), MHSc (Epi)* §

Journal of Pediatric Orthopaedics: July-August 2010 - Volume 30 - Issue 5 - p 430-436
doi: 10.1097/BPO.0b013e3181e00c0d

Background Supracondylar fractures of the humerus are common pediatric elbow injuries. Most displaced or angulated fractures are treated by closed reduction and percutaneous pinning, with either a crossed pin or lateral pin configuration. The purpose of this study was to conduct a systematic review to determine if there is an increased risk of iatrogenic nerve injury associated with the crossed pin configuration.

Methods Relevant articles were identified by searching electronic databases and hand searching-related journal and conference proceedings. Within each trial, the risk of iatrogenic ulnar nerve injury was calculated for each pinning technique. For studies comparing crossed versus lateral pinning, the resulting trial-based differences in risk estimates were pooled using a random effects meta-analysis. A number needed to harm was determined using the pooled risk difference.

Results Thirty-two trials consisting of 2639 patients were used in the pooled analysis. The pooled risk difference of iatrogenic ulnar nerve injury is 0.035 (95% confidence interval, 0.014-0.056), with a higher incidence of injury in the crossed pinning group. The weighed number needed to harm for the crossed pinning is 28 (95% confidence interval, 17-71).

Conclusions The results of this review suggest that there is an iatrogenic ulnar nerve injury for every 28 patients treated with the crossed pinning compared with the lateral pinning. Further research is necessary to ensure that the optimal pinning technique is chosen to treat these factors.

Level of Evidence Level III.

*Department of Orthopaedics, BC Children's Hospital

§Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia

Memorial University of Newfoundland, Division of Orthopaedic Surgery, St John's Newfoundland, Canada

Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK

None of the authors received financial support for this study.

Reprints: Kishore Mulpuri, MBBS, MS (Ortho), MHSc (Epi), Department of Orthopaedics, BC Children's Hospital, A207A-4480 Oak Street, Vancouver, BC V6H 3V4, Canada. Email:

© 2010 Lippincott Williams & Wilkins, Inc.