Ultrasound-guided cross-pin technique for paediatric supracondylar humerus fractures: minimizing iatrogenic ulnar nerve injury
Abstract Background Previous ultrasound-guided cross-pin techniques, which employ 90° elbow flexion, have demonstrated effectiveness; however, they may be associated with an elevated risk of iatrogenic ulnar nerve subluxation or dislocation. The aim of this study was to evaluate the efficacy and saf...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-08-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-025-09001-3 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849735883506319360 |
|---|---|
| author | Xing Wu Xiaoliang Chen Xiongtao Li Teng Wang Jun Li Xiantao Shen |
| author_facet | Xing Wu Xiaoliang Chen Xiongtao Li Teng Wang Jun Li Xiantao Shen |
| author_sort | Xing Wu |
| collection | DOAJ |
| description | Abstract Background Previous ultrasound-guided cross-pin techniques, which employ 90° elbow flexion, have demonstrated effectiveness; however, they may be associated with an elevated risk of iatrogenic ulnar nerve subluxation or dislocation. The aim of this study was to evaluate the efficacy and safety of a modified ultrasound-guided cross-pin technique for reducing the risk of iatrogenic ulnar nerve injury in paediatric patients with supracondylar humerus fractures. Methods This retrospective study was conducted from December 2017- October 2019 and included paediatric patients with displaced supracondylar humerus fractures. The modified ultrasound-guided cross-pin technique was utilized to identify the ulnar nerve and confirm the medial pin position during pin placement with elbow in extension. The primary outcome measure was the incidence of iatrogenic ulnar nerve injury. Results A total of 145 patients (mean age 5.8 years) were enrolled. There were 103 children with Gartland type III fractures, 35 with type II fractures, and 7 with type IV fractures. The incidence of iatrogenic ulnar nerve injury was significantly reduced to 0%. A total of 12 cases had abnormal pin insertions, including 11 cases in which the proximity of the inserted medial pin to the ulnar nerve was close and 1 case in which the ulnar nerve was directly violated by the pin. The rate of pin misplacement was 8.3%. At the latest follow-up, all patients demonstrated excellent and good functional outcomes according to the Flynn criteria. Conclusion The ultrasound-guided cross-pin technique may serve as a viable alternative for reducing the risk of iatrogenic ulnar nerve injury in paediatric patients with supracondylar humerus fractures. |
| format | Article |
| id | doaj-art-5b09268fd14c4dd1851f07bafb6defe7 |
| institution | DOAJ |
| issn | 1471-2474 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj-art-5b09268fd14c4dd1851f07bafb6defe72025-08-20T03:07:26ZengBMCBMC Musculoskeletal Disorders1471-24742025-08-012611810.1186/s12891-025-09001-3Ultrasound-guided cross-pin technique for paediatric supracondylar humerus fractures: minimizing iatrogenic ulnar nerve injuryXing Wu0Xiaoliang Chen1Xiongtao Li2Teng Wang3Jun Li4Xiantao Shen5Department of Pediatric Orthopedic Surgery, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and TechnologyDepartment of Pediatric Orthopedic Surgery, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and TechnologyDepartment of Pediatric Orthopedic Surgery, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and TechnologyDepartment of Pediatric Orthopedic Surgery, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and TechnologyDepartment of Pediatric Orthopedic Surgery, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and TechnologyDepartment of Pediatric Orthopedic Surgery, Tongji Medical College, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Huazhong University of Science and TechnologyAbstract Background Previous ultrasound-guided cross-pin techniques, which employ 90° elbow flexion, have demonstrated effectiveness; however, they may be associated with an elevated risk of iatrogenic ulnar nerve subluxation or dislocation. The aim of this study was to evaluate the efficacy and safety of a modified ultrasound-guided cross-pin technique for reducing the risk of iatrogenic ulnar nerve injury in paediatric patients with supracondylar humerus fractures. Methods This retrospective study was conducted from December 2017- October 2019 and included paediatric patients with displaced supracondylar humerus fractures. The modified ultrasound-guided cross-pin technique was utilized to identify the ulnar nerve and confirm the medial pin position during pin placement with elbow in extension. The primary outcome measure was the incidence of iatrogenic ulnar nerve injury. Results A total of 145 patients (mean age 5.8 years) were enrolled. There were 103 children with Gartland type III fractures, 35 with type II fractures, and 7 with type IV fractures. The incidence of iatrogenic ulnar nerve injury was significantly reduced to 0%. A total of 12 cases had abnormal pin insertions, including 11 cases in which the proximity of the inserted medial pin to the ulnar nerve was close and 1 case in which the ulnar nerve was directly violated by the pin. The rate of pin misplacement was 8.3%. At the latest follow-up, all patients demonstrated excellent and good functional outcomes according to the Flynn criteria. Conclusion The ultrasound-guided cross-pin technique may serve as a viable alternative for reducing the risk of iatrogenic ulnar nerve injury in paediatric patients with supracondylar humerus fractures.https://doi.org/10.1186/s12891-025-09001-3UltrasoundCross-pin techniqueSupracondylar humerus fracturesUlnar nerve injury |
| spellingShingle | Xing Wu Xiaoliang Chen Xiongtao Li Teng Wang Jun Li Xiantao Shen Ultrasound-guided cross-pin technique for paediatric supracondylar humerus fractures: minimizing iatrogenic ulnar nerve injury BMC Musculoskeletal Disorders Ultrasound Cross-pin technique Supracondylar humerus fractures Ulnar nerve injury |
| title | Ultrasound-guided cross-pin technique for paediatric supracondylar humerus fractures: minimizing iatrogenic ulnar nerve injury |
| title_full | Ultrasound-guided cross-pin technique for paediatric supracondylar humerus fractures: minimizing iatrogenic ulnar nerve injury |
| title_fullStr | Ultrasound-guided cross-pin technique for paediatric supracondylar humerus fractures: minimizing iatrogenic ulnar nerve injury |
| title_full_unstemmed | Ultrasound-guided cross-pin technique for paediatric supracondylar humerus fractures: minimizing iatrogenic ulnar nerve injury |
| title_short | Ultrasound-guided cross-pin technique for paediatric supracondylar humerus fractures: minimizing iatrogenic ulnar nerve injury |
| title_sort | ultrasound guided cross pin technique for paediatric supracondylar humerus fractures minimizing iatrogenic ulnar nerve injury |
| topic | Ultrasound Cross-pin technique Supracondylar humerus fractures Ulnar nerve injury |
| url | https://doi.org/10.1186/s12891-025-09001-3 |
| work_keys_str_mv | AT xingwu ultrasoundguidedcrosspintechniqueforpaediatricsupracondylarhumerusfracturesminimizingiatrogeniculnarnerveinjury AT xiaoliangchen ultrasoundguidedcrosspintechniqueforpaediatricsupracondylarhumerusfracturesminimizingiatrogeniculnarnerveinjury AT xiongtaoli ultrasoundguidedcrosspintechniqueforpaediatricsupracondylarhumerusfracturesminimizingiatrogeniculnarnerveinjury AT tengwang ultrasoundguidedcrosspintechniqueforpaediatricsupracondylarhumerusfracturesminimizingiatrogeniculnarnerveinjury AT junli ultrasoundguidedcrosspintechniqueforpaediatricsupracondylarhumerusfracturesminimizingiatrogeniculnarnerveinjury AT xiantaoshen ultrasoundguidedcrosspintechniqueforpaediatricsupracondylarhumerusfracturesminimizingiatrogeniculnarnerveinjury |