Sat., 10/18/08 Foot & Ankle/Pediatrics, Paper #64, 12:17 pm OTA-2008
How Should One Treat Iatrogenic Ulnar Injury after Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral Fractures
Onder Kalenderer, MD (n); Ali Reisoglu, MD (n); Levent Surer, MD (n); Haluk Agus, MD (n);
Orthopedics and Traumatology, Tepecik Educational and Research Hospital, Izmir, Turkey
Objective: The purpose of this study was to assess the 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. Neurologic examination performed immediately after the operation revealed 25 ulnar nerve injuries (5.2%) in patients who had completely normal neurologic findings in the preoperative period. Electromyographic examinations were performed at 6 and 12 weeks postoperatively in patients with ulnar nerve lesions.
Results: The mean age was 6 years (range, 4-8). The mean hospitalization time was 2 days and the mean follow-up time was 30.8 months (range, 17-63). 22 patients with electromyograms showed partial denervation and conduction blocks at the elbow in 6 weeks. Regenerative electromyogram findings were determined in 12 weeks. Sensorial function of all patients had returned in an average 2 months (range, 1-4), while motor function returned in an average of 5.4 months (range, 1-7). All patients had complete return of nerve function and full motion in their elbows.
Conclusion: We evaluated the results of 473 patients; to our knowledge, this is the largest series in the literature. Although the rate of ulnar nerve injuries (5.2%) is comparable with the number of the patients (n = 22), this is again the largest series in the literature and may give us opportunity for more strict conclusions. In our opinion, if ulnar nerve injury is detected after the operation, patients should be followed for 7 months without intervention.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.