JOT - 2026-08-13 - Journal Article
Postoperative subclinical nerve injury after closed reduction and percutaneous pinning of paediatric supracondylar humerus fractures: a prospective Electromyographic study.
Kandemir İ, İğrek S, İnan RA, Bayhan M, Zihni H, Eceviz E
Topics
Key Takeaway
EMG detected subclinical ulnar nerve axonal injury in 19.2% of pediatric patients after CRPP for Gartland III/IV supracondylar humerus fractures, with posterior medial pin entry site carrying an OR of 6.745 for injury.
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Summary
This prospective cohort study evaluated EMG-detected subclinical nerve injury in 73 pediatric patients with Gartland III/IV supracondylar humerus fractures treated with CRPP who had normal pre- and postoperative clinical neurovascular exams. EMG identified axonal injury in 19.2% (ulnar) and 6.8% (median) of patients, with no radial nerve injuries. Posterior medial pin entry in the sagittal plane was an independent risk factor for ulnar nerve injury (OR 6.745; p=0.033), and operative time >1 hour correlated significantly with ulnar nerve injury (p=0.007).
Key Limitation
No follow-up EMG was performed to determine the natural history or recovery rate of the subclinical axonal injuries detected, leaving the clinical significance of these findings uncertain.
Original Abstract
OBJECTVES
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.