Shtarker Haim, Elboim-Gabyzon Michal, Bathish Einal, Laufer Yochy, Rahamimov Nimrod, Volpin Gershon
*Western Galilee Hospital, Nahariya, Israel †Physical Therapy Department, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
J Pediatr Orthop. 2014 Mar;34(2):161-5. doi: 10.1097/BPO.0000000000000084.
Supracondylar fractures of the humerus in children are frequently managed by closed reduction and percutaneous pinning. Insertion of medial and lateral pins is more stable than lateral pinning alone, but carries an increased risk for ulnar nerve damage. This study describes the use of electrical stimulation concurrent with medial pin insertion as a monitoring technique for avoiding iatrogenic ulnar nerve injury.
A retrospective review was conducted on 138 children, mean age 5.6 years (SD±2.5), who were admitted to the hospital between 2007 and 2010 with uncomplicated supracondylar fractures, Gartland type II and above, and intact neurovascular presentation. The location of the ulnar nerve was identified and marked preoperatively by observing twitch contractions in response to electrical stimulation. The medial pin served as an active electrode during pin insertion, and repeated stimulation throughout the insertion process ensured no contact with the response of the ulnar nerve. After pin insertion, ulnar nerve stimulation was used again to ensure nerve continuity viability.
All fractures were stabilized with 2 to 4 cross K-wires (size 1.6 mm), with number depending on stability of the fracture. The children were discharged home 2 days after fracture fixation, with no iatrogenic ulnar nerve injury observed in any of the children. The only postoperative complication involved 2 cases of anterior interosseus nerve neuropraxia, which resolved spontaneously after 4 to 6 months. Primary fracture healing was achieved without nonunions or delayed unions in all cases.
Ulnar nerve stimulation before and during the percutaneous pinning of supracondylar fractures in children is a simple, economical, and easy-to-implement technique that can prevent iatrogenic ulnar nerve injury.
Level IV.
儿童肱骨髁上骨折常采用闭合复位经皮穿针固定治疗。内侧和外侧穿针固定比单纯外侧穿针更稳定，但尺神经损伤风险增加。本研究描述了在插入内侧针时同时使用电刺激作为一种监测技术，以避免医源性尺神经损伤。
对2007年至2010年间因单纯性Gartland II型及以上肱骨髁上骨折且神经血管状况完好而入院的138例儿童进行回顾性研究，平均年龄5.6岁（标准差±2.5）。术前通过观察对电刺激的抽搐收缩来确定和标记尺神经的位置。在穿针过程中，内侧针作为有源电极，在整个插入过程中反复刺激以确保不接触尺神经的反应。穿针后，再次使用尺神经刺激以确保神经连续性和活力。
所有骨折均用2至4根交叉克氏针（直径1.6 mm）固定，数量取决于骨折的稳定性。骨折固定后2天患儿出院，所有患儿均未观察到医源性尺神经损伤。唯一的术后并发症为2例骨间前神经失用症，4至6个月后自行缓解。所有病例均实现了一期骨折愈合，无骨不连或延迟愈合。
在儿童肱骨髁上骨折经皮穿针固定之前和过程中进行尺神经刺激是一种简单、经济且易于实施的技术，可预防医源性尺神经损伤。
IV级。
