Evaluation of Intraoperative Peripheral Nerve Stimulator Assisted Percutaneous Medial Pin Placement for Supracondylar Humerus Fractures in Children

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Abstract Background: Supracondylar fractures of the humerus are widely regarded as the most common fractures around the elbow in pediatric age group, and account for around 60–70% of all pediatric elbow fractures. Proper management of supracondylar fractures is important as they may lead to undesired catastrophic consequences. The treatment options depend on the fragment displacement degree and the presence of a neurovascular injury. An accepted widely known classification of these fractures is the AO/Gartland system, as modified by Wilkin. Objective: To assess the accuracy, feasibility, and reliability of the peripheral nerve stimulator during and after medial pin placement in surgical management of supracondylar fractures in children. Patients and Methods: This prospective interventional clinical trial was conducted on 50 children with supracondylar fracture of humerus; in the Orthopedics Department of Suad Kafafi Teaching Hospital, Misr University for Science and Technology, School of Medicine, Cairo, Egypt. All patients were subjected to complete clinical picture and careful clinical examination. All patients needed X-ray films; AP/lateral view. Results: Age was distributed as 6.28 ± 2.36 years with minimum of 2 years and maximum of 11 years. Regarding sex distribution, male represents majority with 72% and female with 28%. Median time before surgery was zero with minimum of zero and maximum of 8 days. Intraoperatively, medial epicondyle was palpated in all patients. Conclusion: The peripheral nerve stimulation during the percutaneous medial pinning of supracondylar fractures in children is a simple, economical, and easily implemented technique, which is helpful in avoiding iatrogenic injury. It can be applied with the equipment already existing in the operation room, as it is also routinely used by anesthesiologists.

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