Ultrasound-guided Percutaneous Medial Pinning of Pediatric Supracondylar Humeral Fractures to Avoid Ulnar Nerve Injury.
نویسندگان
1 Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain
2 Radiology Department, UIME, Hospital da Luz, Lisboa, Portugal
3 Pediatric Orthopedic Surgery Department, Hospital Beatriz Angelo, Lisboa, Portugal
4 Pediatric Orthopedic Surgery Department, Hôpital des Enfants, CHU Toulouse, France
5 Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain
6 Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain
7 Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain
8 Orthopedic Surgery, Hand and Upper Extremity Surgery, Centre de la Ma de Barcelona (Barcelona Hand Center), Spain
doi
10.22038/abjs.2015.4274چکیده
Background: Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar fractures (SHF) owing to the risk of ulnar nerve injury. Aim: To evaluate the safety and usefulness of medial pinning for SHF using ultrasound imaging for ulnar nerve visualization. Methods: Fifteen children, with a mean age of 60 months, with displaced SHF were treated with a crossed-pinning configuration after fracture reduction. Intraoperative ultrasound was used to guide medial pin insertion to avoid ulnar nerve injury. Results: Cubital tunnel anatomy was easily identified in all children. All children showed a subluxating ulnar nerve that required elbow extension to about 90º before medial pin insertion. None suffered ulnar nerve dysfunction after using the referred technique. Conclusions: Although technically demanding, ultrasound may be a valuable adjuvant to avoid ulnar nerve injury while performing a medial pinning in pediatric SHF.
