Evidence map›Paper›PMID 40721788›Full record

ArticleBMC musculoskeletal disorders2025

Radiographic identification method of safe medial pinning zone and its clinical efficacy in pediatric supracondylar humeral fracture fixation.

Hongbin Liu, Yong Zhu, Yi Hu, Kaihu Li, Haitao Long, Zhangyuan Lin, Ruibo Zhao, Buhua Sun, Shushan Zhao, Liang Cheng

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Article in BMC musculoskeletal disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Hongbin LiuDepartment of Orthopedics, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, 710000, China.
Yong ZhuDepartment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Yi HuDepartment of Orthopedics, The First People's Hospital of Changde City, Changde, Hunan, 415000, China.
Kaihu LiDepartment of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410000, China.
Haitao LongDepartment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Zhangyuan LinDepartment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Ruibo ZhaoDepartment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Buhua SunDepartment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Shushan ZhaoDepartment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Liang ChengDepartment of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China. doccheng@csu.edu.cn.

Funding

National Natural Science Foundation of China 81902277Natural Science Foundation of Hunan Province 2021JJ30038
6 · The paper itself

Abstract

objectivesPreventing iatrogenic ulnar nerve injury remains a critical challenge during medial pinning in pediatric supracondylar humeral fractures (SCHFs). This study seeks to define a safe zone for medial pin insertion and evaluate its effectiveness in minimizing complications.

methodsThree-dimensional reconstructions of radiographs from a healthy elbow joint were generated using E3d software to delineate a safe medial pinning zone. Pediatric patients with modified Gartland type III or IV SCHFs who underwent closed reduction and percutaneous crossed pin fixation were categorized into two groups based on the medial pin entry point observed via intraoperative fluoroscopy. A retrospective analysis was performed to assess the safety and effectiveness of pin placement. Furthermore, in a case of postoperative ulnar nerve dysfunction, the standard medial pinning technique was replaced with the defined safe entry approach.

resultsOn the anteroposterior (AP) view, the upper segment of the oblique line was identified as the safe zone, as the ulnar nerve lies within the groove at the lower segment. On the lateral view, a diamond-shaped area was confirmed as the safe insertion zone for medial pinning. The study included 134 SCHF cases, divided into group A (74 cases), where medial Kirschner wire (K-wire) placement was within the defined safe zones in both views, and group B (60 cases), where placement occurred outside these zones. The incidence of ulnar nerve injury in group A was significantly lower than in group B (P = 0.0324). Additionally, exploration and neurolysis were performed in cases of postoperative ulnar nerve dysfunction. A left-handed maneuver during surgery was found to aid in the precise identification of the safe entry site for medial pinning.

conclusionsMedial pinning performed within the delineated safe zone, with guidance from intraoperative fluoroscopy, significantly reduces the likelihood of iatrogenic ulnar nerve injury in pediatric SCHF patients. LEVEL OF EVIDENCE: Level III retrospective comparative study.

Indexed as

Bone NailsFracture Fixation, InternalHumeral FracturesAdolescentBone WiresChildChild, PreschoolElbow JointFemaleFluoroscopyHumansImaging, Three-DimensionalMaleRetrospective StudiesTreatment OutcomeUlnar NerveIntraoperative fluoroscopyMedial pinningPediatricSupracondylar humeral fractureUlnar nerve injury

Identifiers

PMID40721788
PMCPMC12305892

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