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Sliding the Medial Pin

A Safer Approach to Cross-pinning Humerus Supracondylar Fractures?

Wong, Kenneth Pak Leung MB BCh BAO, LRCP and SI (Ire), MRCS (Ed), MMed, Ortho (Singapore), FRCS Ortho (Ed); Chew, Ee Ming MBBS (Singapore), MRCS (Ed), MMed (Singapore), FAMS (Hand Surgery); Mahadev, Arjandas MBBS (Singapore), FRCS Ortho (Ed), FAMS (Ortho)

Techniques in Hand & Upper Extremity Surgery: September 2019 - Volume 23 - Issue 3 - p 111–114
doi: 10.1097/BTH.0000000000000230

Introduction: Many methods have been described to minimize the risk of ulnar nerve injury during the insertion of a medial pin for the percutaneous pinning of pediatric supracondylar humerus fractures (SCHF). The most recent AAOS Clinical Practice Guidelines suggests that physicians might want to avoid the use of medial-entry pins due to considerations of potential injury to the ulnar nerve. However, there are circumstances whereby a cross pin configuration is required. These include cases where there is medial wall comminution or due to the obliquity of the fracture. In this study, we present a group of patients with SCHF in which the medial pin was inserted using a new technique.

Materials and Methods: This is a retrospective case series approved by the local centralized institutional review board. The medical records of all patients who underwent closed reduction and percutaneous pinning for SCHF using a new technique—the sliding method—by a single pediatric orthopedic surgeon from August 2017 till January 2018 were reviewed. Patient demographics, fracture type, operative time, postoperative Baumann’s angle, postoperative lateral capitellohumeral angle, and the rate of ulnar nerve palsy were recorded.

Results: This new technique was used in a total of 35 patients. Two patients were excluded as one had multiple same limb injuries, while another had a Gustilo 3A humerus supracondylar fracture. The average patient age at the time of surgery was 6.2 years (range: 2 to 12 y). There were 22 children with Gartland grade 3 fractures, 10 with grade 2b fractures, and 1 had a flexion type fracture. The average operative time was 21 minutes (range: 7 to 58 min). The average postoperative Baumann’s angle was 73.9 degrees (range: 63.8 to 79.6 degrees) and the average postoperative lateral capitellohumeral angle was 44.6 degrees (range: 31.1 to 56.8 degrees). There were no cases of ulnar nerve palsy.

Conclusions: The sliding method is a novel technique of protecting the ulnar nerve during closed reduction percutaneous pinning of SCHF.

Level of Evidence: Level IV.

Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore, Singapore

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Kenneth Pak Leung Wong, MB BCh BAO, LRCP and SI (Ire), MRCS (Ed), MMed, Ortho (Singapore), FRCS Ortho (Ed), Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore. E-mail:

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