THE USE OF NERVE STIMULATION DURING PERCUTANEOUS PINNING OF SUPRACONDYLAR FRACTURES IN CHILDREN

Abstract

Purpose: Biomechanical studies have shown that fixation by two lateral pins of supracondylar fractures in children provide less stability than crossed pin fixation from lateral and medial sides. However, closed percutaneous medial pin fixation may be associated with ulnar nerve injury. Soft tissue edema or excessive mobility of ulnar nerve may be predisposing factors for iatrogenic ulnar nerve injury. We present our experience with the use of nerve stimulator in preventing such complications during surgery.

Material and Methods: During the last two years 22 children with supracondylar fractures (20- extension type; 2- flexion type) underwent surgery by closed reduction and percutaneous crossed KW fixation. The average age was 5.3 years (range 3–9 years). Detection of the ulnar nerve location was made possible by continuous intraoperative use of nerve stimulator, connected to the medial pin during its insertion. In 4/22 Pts irritation of ulnar nerve during pin insertion was observed by the appearance of clear contractions of forearm and hand muscles, and therefore, the location of the medial pin was immediately changed.

Results: In all cases anatomic reduction was achieved. No cases of nerve or vascular injury were observed. No cases of secondary fracture displacement were noted.

Conclusions: Based on this study it seems that the use of intraoperative nerve stimulator, during percutaneous crossed pin fixation of supracondylar fractures in children, may assist in localizing the nerve and prevent its injury during medial pin insertion. Changes in original setting of the standard anesthesiology nerve stimulator may be performed easily in order to allow such monitoring. The use of nerve stimulator during such procedures is very simple, even in cases of emergency. Monitoring of ulnar nerve by nerve stimulator is reliable and enables safe pin placement, decreasing the risk of nerve injury.