title: The medial epicondyle-ulnar nerve relation with various elbow positions in healthy children.
abstract: BACKGROUND
  The position of the ulnar nerve relative to the medial epicondyle in healthy children was determined with a high-resolution ultrasonography with elbow flexion, forearm pronation, and supination maneuvers which are commonly employed during reduction of the supracondylar humerus fractures.
  
  
  METHODS
  Healthy children aged between 4 and 12 years were enrolled in this study. Both elbows of the children were evaluated with a high-resolution sonography device with gradual flexion of the elbow, whereas the forearm is alternately in pronation and supination. The medial epicondyle-ulnar nerve distance was measured with the various positions of the elbow and the forearm. One-way analysis of variance was used to analyze the differences of medial epicondyle-ulnar nerve distance at different elbow flexion angles and forearm supination-pronation positions. Paried t test was used to compare the differences between the age and sex of the children.
  
  
  RESULTS
  Twelve female and 26 male children (76 elbows) with a mean age of 8.36 years were included in the study. Ulnar nerve was translated anteriorly through the medial epicondyle with increasing elbow flexion. The mean medial epicondyle-ulnar nerve distance that was 3.7 mm in an extended elbow decreased to 1.1 mm with full elbow flexion. The difference was statistically significant (P<0.0001). Presence of the forearm in either supination or pronation did not produce a statistically significant difference. The age and sex of the children did not produce a statistically significance difference in medial epicondyle-ulnar nerve distance.
  
  
  CONCLUSIONS
  Flexion of the elbow brings the ulnar nerve to a close proximity to the medial epicondyle independent of forearm pronation and supination in healthy children. The decrement of the medial epicondyle-ulnar nerve distance up to 1.1 mm in a fully flexed elbow might be a factor that endangers the nerve during medial pinning in supracondylar humerus fractures.
  
  
  METHODS
  Level I-diagnostic studies.
authors.affiliation: School of Medicine, Marmara University, İstanbul, Turkey.
authors.forename: Yakup
authors.initials: Y
authors.lastname: Yıldırım
authors.forename: Motasım
authors.initials: M
authors.lastname: Bawaneh
authors.forename: Tevfik
authors.initials: T
authors.lastname: Balıkçı
authors.forename: Hacer
authors.initials: H
authors.lastname: Bal
mesh_terms: D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D004550:Elbow / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000502:physiology*; D004551:Elbow Joint / Q000000981:diagnostic imaging; D005260:Female; D005542:Forearm / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000502:physiology; D006801:Humans; D008297:Male; D011187:Posture / Q000502:physiology*; D011403:Pronation / Q000502:physiology; D016059:Range of Motion, Articular / Q000502:physiology*; D012016:Reference Values; D013484:Supination / Q000502:physiology; D014459:Ulnar Nerve / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000502:physiology*; D014463:Ultrasonography