DOI: 10.1097/bot.0000000000003258 ISSN: 0890-5339

Postoperative subclinical nerve injury after closed reduction and percutaneous pinning of paediatric supracondylar humerus fractures: a prospective Electromyographic study

İbrahim Kandemir, Servet İğrek, Rahsan Adviye İnan, Mazlum Bayhan, Hüseyin Zihni, Engin Eceviz
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OBJECTİVES:

To detect early postoperative subclinical nerve injury in pediatric supracondylar humerus fractures and to identify associated risk factors.

METHODS:

Design : Prospective cohort study

Setting:

Single Level 1 trauma center

Patient selection criteria:

Patients aged 1–12 yr with Gartland type III and IV supracondylar humerus fractures, normal preoperative and postoperative neurovascular examinations, and treated with closed reduction and percutaneous pinning (CRPP) between April 2024 and 2025 were included.

Outcome Measures and Comparisons:

The primary outcome was electromyography (EMG)–detected axonal injury of the median, ulnar, or radial nerves, assessed within the first week after pin removal at 1 month postoperatively. Secondary outcomes included identification of surgical and radiographic risk factors for ulnar nerve injury. Multivariable logistic regression analysis was performed to determine independent predictors.

RESULTS:

A total of 73 pediatric patients (31 females and 42 males; mean age, 5.68 ± 2.35yr) were analyzed. EMG findings were normal in 74% (54/73) of patients. Axonal injury was detected in the ulnar nerve in 19.2% (14/73) of patients and in the median nerve in 6.8%(5/73), whereas no radial nerve injury was observed. Among the 14 patients with ulnar nerve injury treated with cross-pinning, the medial pin was positioned posteriorly in the sagittal plane in 85.7% (12/14) and in a inferior position in the coronal plane in 100% (14/14). Posteriorly and inferiorly positioned medial pin insertion sites were associated with significantly higher rates of ulnar nerve injury detected on EMG. ( p = 0.024 and p = 0.037, respectively). Logistic regression analysis identified a posterior pin entry site in the sagittal plane as an independent risk factor ( p =0.033; OR, 6.745; 95% CI, 1.16–39.00). Among patients with ulnar nerve injury, 71.4% (10/14) had an operative time exceeding one hour. In addition operative time was significantly longer in patients with ulnar nerve injury ( p = 0.007). Interobserver agreement for radiographic measurements was excellent (intraclass correlation coefficient (ICC) = 0.864–0.897; 95% CI,0.807–0.907; p < 0.01).

CONCLUSIONS:

Subclinical ulnar nerve injury may occur in pediatric patients with clinically normal postoperative findings following CRPP. EMG detection suggests that injury is associated with a posterior–inferior medial pin entry site. Careful medial pin placement and minimizing operative time may reduce preventable technical risks during CRPP.

Level of Evidence:

Level II, therapeutic study

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