How should one treat iatrogenic ulnar injury after closed reduction and percutaneous pinning of paediatric supracondylar humeral fractures?

Abstract

Objective: The purpose of this study was to assess iatrogenic ulnar nerve injuries after supracondylar humeral fractures treated with closed reduction and percutaneous pinning.

Methods: The series consisted of 473 children. All patients were treated with closed reduction and percutaneous pinning. Neurological examination performed immediately after the operation revealed 25 ulnar nerve injuries (5.2%) in patients who had completely normal neurological findings in the preoperative period. Electromyographic examinations were performed at 6 and 12 weeks postoperatively in patient with ulnar nerve lesions.

Results: The mean age was 6 years (4-8 years). The mean hospitalisation time was 2 days and the mean follow-up time was 30.8 months (17-63 months). Twenty-two patients with electromyogram showed partial denervation and conduction blocks at the elbow at 6 weeks. Regenerative electromyogram findings were found at 12 weeks. Sensory function in all patients had returned at a mean of 2 months (1-4 months) while motor function had returned at a mean of 5.4 months (1-7 months). Unusually all patients had complete return of nerve function and full motion in their elbows.

Conclusion: We evaluated the results of 473 patients and to our knowledge this is the largest series in the literature. Although the rate of ulnar nerve injuries (5.2%) is comparable, the number of the patients (n: 22) is the largest in the literature and may allow us to draw stronger conclusions. In our opinion, if ulnar nerve injury is detected after the operation, patients should be followed up for 7 months without intervention.