TechniquesManagement of Supracondylar Fractures in the Prone Position: Case Series, Technique, and Literature ReviewSchaver, Andrew L. BS*; Akeson, Jeffrey W. MD†; Kinzinger, Robert A. MD‡; Ramirez, Miguel A. MD*,‡Author Information *University of Illinois College of Medicine Peoria (UICOMP) †Midwest Orthopaedic Center ‡OSF Orthopedics, Peoria, IL J.W.A. owns stock or stock options in Matinas. M.A.R. is a member of the editorial board of the Journal of Shoulder and Elbow Surgery. He is also a paid consultant, paid presenter or speaker for Stryker. The remaining authors declare no conflict of interest. Reprints: Miguel A. Ramirez, MD, University of Illinois College of Medicine at Peoria IRB 1, Peoria, IL 61605 (e-mail: [email protected]). Techniques in Shoulder & Elbow Surgery: December 2020 - Volume 21 - Issue 4 - p 112-115 doi: 10.1097/BTE.0000000000000209 Buy Metrics Abstract In displaced supracondylar humerus fractures, closed reduction percutaneous pinning is recommended and is most commonly performed in the supine position with the arm held in hyperflexion. The risk of iatrogenic ulnar nerve injury with medial pin placement is high in this position. We performed a retrospective case series of 149 patients with displaced supracondylar humerus fractures treated in the prone position. The aim of this study was to evaluate the incidence of iatrogenic ulnar nerve injury with medial pin placement, report our technique, and conduct a literature review to serve as historical control. The rate of iatrogenic ulnar nerve injury was evaluated and compared with a historical control cohort of 1029 patients treated supine. A total of 131 patients were included: 74 (56%) patients received a medial pin, and 57 (44%) patients received lateral pins only. Postoperative complications included 2 cases of pin migration (1.5%). No patients sustained iatrogenic ulnar nerve injury, compared with a historical control rate of 4.95%. Our technique is correlated with a lower incidence of ulnar nerve injuries than historical controls performed in the supine position. We believe this technique can facilitate safer pin placement in cases that require a medial pin. Level of Evidence: Level IV. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.