ultrasound-guided percutaneous medial pinning of pediatric supracondylar humeral fractures to avoid ulnar nerve injury.

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. aim: 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.