Abstract
Aim: To assess the risk of iatrogenic ulnar nerve injury using the mini medial incision to reduce and stabilise displaced supracondylar fractures of the humerus in children with crossed K-wires.
Methods: We performed a retrospective evaluation of 26 children with closed Wilkins type IIB and III supracondylar fractures of the humerus, without vascular deficit, between January 1999 and April 2007. Mean age was 5.5 years (2.5–11 years). All were treated with open reduction and crossed K-wire fixation using a mini medial incision (5cm). Our modification is that we do not expose the fracture site or the ulnar nerve. It is a “feel” rather than “see” approach. The medial K-wire is placed under direct vision. All patients had early and late (4 months) post-operative ulnar nerve assessment. Patient outcome was assessed clinically using Flynn’s classification and radiologically using the metaphyseal-diaphyseal and humerocapitellar angles. Mean length of follow-up was 5 months (4–8 months).
Results: There was no post-operative ulnar nerve injury. Clinically and radiologically there were 23 excellent and 3 good results.
Conclusions: The mini medial incision is simple. It provides an excellent view for correct medial pin entry; hence it reduces the risk of iatrogenic ulnar nerve injury. Crossed K-wires provide a stable and reliable fixation.
Correspondence should be addressed to BSCOS c/o BOA, at the Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London, WC2A 3PE, England.
