K Wire fixation of supra-condylar humerus fractures in children. Is ulnar nerve at risk?

Objective: To compare iatrogenic ulnar nerve injury in lateral entry pin fixation versus medial and lateral entry pin fixation in the treatment of supracondylar fractures of the humerus in children. Measurement of clinical parameters in terms of elbow range of motion and postop radiographic alignment was also targeted. Methods: The retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, and comprised data of paediatric patients who underwent closed reduction and percutaneous pin fixation for the treatment of displaced extension type supracondylar fractures of the humerus between July 2007 and June 2012. Data regarding socio-demographic status, disease and procedure variables was collected from patient files and was analysed using SPSS 19. Results: There were 71patients; 37(52%) in the lateral entry group and 34(48%) in the medial and lateral entry group. The two groups were similar in terms of mean age, gender distribution, and preoperative displacement, comminution, and associated vascular and nerve status (p>0.05 each). There were no cases of iatrogenic ulnar nerve injury in either group and no significant differences between groups with respect to the elbow range of motion and radiological parameters (p>0.05 each). Conclusions: With the use of the specific techniques employed, both lateral entry pin fixation and medial and lateral entry pin fixation were effective in the treatment of displaced extension type supracondylar humerus fractures in children.