title: Ultrasound-guided Percutaneous Medial Pinning of Pediatric Supracondylar Humeral Fractures to avoid Ulnar Nerve Injury.
abstract: BACKGROUND
  Medial pinning is one of the most controversial aspects of the surgical treatment of supracondylar fractures (SHF) owing to the risk of ulnar nerve injury.
  
  
  OBJECTIVE
  To evaluate the safety and usefulness of medial pinning for SHF using ultrasound imaging for ulnar nerve visualization.
  
  
  METHODS
  Fifteen children, with a mean age of 60 months, with displaced SHF were treated with a crossed-pinning configuration after fracture reduction. Intraoperative ultrasound was used to guide medial pin insertion to avoid ulnar nerve injury.
  
  
  RESULTS
  Cubital tunnel anatomy was easily identified in all children. All children showed a subluxating ulnar nerve that required elbow extension to about 90º before medial pin insertion. None suffered ulnar nerve dysfunction after using the referred technique.
  
  
  CONCLUSIONS
  Although technically demanding, ultrasound may be a valuable adjuvant to avoid ulnar nerve injury while performing a medial pinning in pediatric SHF.
authors.affiliation: Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Soldado
authors.affiliation: Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Knorr
authors.affiliation: Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain.
authors.forename: Sleiman
authors.initials: S
authors.lastname: Haddad
authors.affiliation: Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Diaz-Gallardo
authors.affiliation: Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Palau-Gonzalez
authors.affiliation: Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain.
authors.forename: Vasco V
authors.initials: VV
authors.lastname: Mascarenhas
authors.affiliation: Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain.
authors.forename: Samir
authors.initials: S
authors.lastname: Karmali
authors.affiliation: Pediatric Upper Limb and Microsurgery, Hospital Sant Joan de Deu Barcelona, Spain.
authors.forename: Jérôme Sales
authors.initials: JS
authors.lastname: de Gauzy
keywords: Elbow pinning; Musculoskeletal ultrasound; Pediatric elbow; Pediatric supracondylar elbow fractures; Ulnar nerve