Ultrasound-guided Percutaneous Medial Pinning of Pediatric Supracondylar Humeral Fractures to Avoid Ulnar Nerve Injury.

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.