Iatrogenic radial nerve injury with cannulated fixation of medial epicondyle fractures in the pediatric humerus: a report of 2 cases

Abstract

Surgical treatment for medial epicondylar fractures is controversial, and indications depend on variety of variables, including the degree of displacement and future goals of the patient. If surgery is to be performed, typically open reduction of the medial epicondylar fragment, with visualization of the ulnar nerve, and fixation is undertaken. Pins, screws, and cannulated screws have all been described for fixation. The use of cannulated screw systems, especially when coupled with fluoroscopy, has many advantages, and is generally considered a safe way to place a screw accurately while minimizing the surgical exposure. Unfortunately, there are also inherent risks with a cannulated screw system that often go unrecognized, such as guide pin bending, breakage or unrecognized advancement. The complications are rarely reported, and recognition is critical to avoid future complications. This is the first study to report a radial nerve injury after the use of cannulated screw systems in 2 patients with a pediatric medial epicondyle fracture fixation. This study highlights the danger of these systems for this fracture fixation, and we discuss the potential techniques to avoid this complication. Our purpose in publishing this series of cases is to shed light on a complication, in the hope that its exposure will help prevent such complications in the future.

Level of evidence: IV, Case Series.