Percutaneous K-wire Fixation Of Supracondylar Humerus Fractures In Children - Techniques To Minimise Occurrence Of Ulnar Nerve Injuries Through Experiments On Sheep.

摘要

Ulnar nerve injury following medial wire placement in percutaneous fixation of supraconylar humeral fractures is well recognised. We investigated techniques that may be used to minimise the occurrence and severity of nerve lesions when using percutaneous methods. 4 sheep post euthanasia had K-wires passed through percutaneous nerves before fixation to underlying bone. From our experiments we were able to conclude that the use of sharp wires of minimum diameter passed perpendicular to the long axis of the nerve before spinning into bone was commenced resulted in minimal nerve injury when compared with our other methods of wire passage. INTRODUCTION Ulnar nerve injury following closed reduction and percutaneous K-wire fixation of supracondylar humeral fractures is well documented. Authors have reported the incidence of ulnar nerve injury as ranging from 1.5 - 5.5.% 1,2,3,4 when utilising this technique. By experimental techniques practised on sheep this study investigates methods by which ulnar nerve trauma may be minimised when utilising percutaneous methods. METHODS Our investigation involved the use of 4 sheep immediately post euthanasia. The lumbosacral and brachial plexus percutaneous branches were exposed in each limb. Sites along the anatomical path of these nerves were selected which lay directly over bone.K-wires were then passed through the nerve and fixed to directly underlying bone.