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Purpose: This multicenter, retrospective cohort study aimed to compare the risk of ulnar nerve injury in pediatric supracondylar humeral fractures treated with percutaneous lateral-pins, blinded-crossed-pins, and crossed-pins with a mini-incision. Methods: Data were collected from 1705 children treated between January 2010 and December 2023 at four orthopedic centers in Colombia. The incidence of postoperative ulnar nerve injury was compared among three fixation techniques: lateral-pin, blinded-crossed-pin, and crossed-pin with a mini-incision. Results: A statistically significant difference in nerve injury rates was observed between the lateral-pin and both blinded-crossed-pin and mini-incision crossed-pin techniques (p < 0.001), with the lateral-pin technique demonstrating a significantly lower risk of injury. No significant difference was found between the blinded-crossed-pin and mini-incision crossed-pin techniques (p = 0.67). Conclusion: Crossed-pin fixation was associated with a higher incidence of ulnar nerve injury, regardless of the use of a mini-incision. The lateral-pin technique remains the safest option for minimizing iatrogenic nerve injury. There is insufficient evidence to support the mini-incision as a safer alternative to traditional crossed-pin fixation. [ABSTRACT FROM AUTHOR]

Background: Peripheral nerve injuries (PNIs) of the upper limb are very common events within the pediatric population, especially following soft tissue trauma and bone fractures. Symptoms of brachial plexus nerve injuries can differ considerably depending on the site and severity of injury. Compared to median and radial nerves, the ulnar nerve (UN) is the most frequently and severely injured nerve of the upper extremity. Indeed, due to its peculiar anatomical path, the UN is known to be particularly vulnerable to traumatic injuries, which result in pain and substantial motor and sensory disabilities of the forearm and hand. Therefore, timely and appropriate postoperative management of UN lesions is crucial to avoid permanent sensorymotor deficits and claw hand deformities leading to lifelong impairments. Nevertheless, the literature regarding the rehabilitation following PNIs is limited and lacks clear evidence regarding a solid treatment algorithm for the management of UN lesions that ensures full functional recovery. Case presentation: The patient is a 11-year-old child who experienced left-hand pain, stiffness, and disability secondary to a domestic accident. The traumatic UN lesion occurred about 8 cm proximal to Guyon's canal and it was surgically treated with termino-terminal (end-to-end) neurorrhaphy. One month after surgery, the patient underwent multimodal rehabilitative protocol and both subjective and functional measurements were recorded at baseline (T0) and at 3- (T1) and 5-month (T2) follow-up. At the end of the rehabilitation protocol, the patient achieved substantial reduction in pain and improvement in quality of life. Of considerable interest, the patient regained a complete functional recovery with satisfactory handgrip and pinch functions in addition with a decrease of disability in activities of daily living. Conclusion: A timely and intensive rehabilitative intervention done by qualified hand therapist with previous training in the rehabilitation of upper limb neuromuscular disorders is pivotal to achieve a stable and optimal functional recovery of the hand, while preventing the onset of deformities, in patients with peripheral nerve injuries of the upper limb. [ABSTRACT FROM AUTHOR]

The existing literature has explored carpal tunnel syndrome (CTS) and determined that it could be a risk for coronary artery disease (CAD), but there has been little research comparing the relevance of CAD with other neuromuscular disorders (NMDs) to CTS. This case–control study explored the association between CTS, stenosing tenosynovitis (ST), and ulnar side NMDs and CAD. The study utilized data from Taiwan's National Health Insurance Research Database, focusing on health insurance claims. Between January 2000 and December 2011, we employed the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes to identify 64,025 CAD patients as the case group. The control group consisted of an equal number of individuals without CAD, matched for age, sex, and index year of CAD. Logistic regression analysis was employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for each variable. Multivariate analysis, after adjusting for sociodemographic factors and comorbidities, revealed a significantly higher likelihood of a previous diagnosis of CTS in the CAD group compared to the comparison control group. However, neither ST nor the ulnar side NMDs had any statistical significance. These results indicated that median nerve injury, rather than other NMDs, may uniquely serve as a predisposing factor of CAD. [ABSTRACT FROM AUTHOR]

BackgroundPeripheral nerve injuries (PNIs) of the upper limb are very common events within the pediatric population, especially following soft tissue trauma and bone fractures. Symptoms of brachial plexus nerve injuries can differ considerably depending on the site and severity of injury. Compared to median and radial nerves, the ulnar nerve (UN) is the most frequently and severely injured nerve of the upper extremity. Indeed, due to its peculiar anatomical path, the UN is known to be particularly vulnerable to traumatic injuries, which result in pain and substantial motor and sensory disabilities of the forearm and hand. Therefore, timely and appropriate postoperative management of UN lesions is crucial to avoid permanent sensorymotor deficits and claw hand deformities leading to lifelong impairments. Nevertheless, the literature regarding the rehabilitation following PNIs is limited and lacks clear evidence regarding a solid treatment algorithm for the management of UN lesions that ensures full functional recovery.Case presentationThe patient is a 11-year-old child who experienced left-hand pain, stiffness, and disability secondary to a domestic accident. The traumatic UN lesion occurred about 8 cm proximal to Guyon’s canal and it was surgically treated with termino-terminal (end-to-end) neurorrhaphy. One month after surgery, the patient underwent multimodal rehabilitative protocol and both subjective and functional measurements were recorded at baseline (T0) and at 3- (T1) and 5-month (T2) follow-up. At the end of the rehabilitation protocol, the patient achieved substantial reduction in pain and improvement in quality of life. Of considerable interest, the patient regained a complete functional recovery with satisfactory handgrip and pinch functions in addition with a decrease of disability in activities of daily living.ConclusionA timely and intensive rehabilitative intervention done by qualified hand therapist with previous training in the rehabilitation of upper limb neuromuscular disorders is pivotal to achieve a stable and optimal functional recovery of the hand, while preventing the onset of deformities, in patients with peripheral nerve injuries of the upper limb.

This study aims to investigate the clinical efficacy of the olecranon osteotomy approach and the Bryan-Morrey approach in total elbow arthroplasty (TEA). In this retrospective study, 49 patients with elbow disease were treated with TEA. A total of 22 patients with TEA by olecranon osteotomy approach were designated as group A, and 27 patients with TEA by Bryan-Morrey approach were designated as group B. There were 22 males and 27 females, aged 32-82 years with a mean age of 62 years. There were 44 cases of unilateral elbow joint, including 27 cases on the left elbow and 17 cases on the right elbow, and 5 cases of the bilateral elbow joint. There were 6 cases of osteoarthritis (7 elbows), 18 cases of rheumatoid arthritis (22 elbows), 14 cases of traumatic arthritis (14 elbows), 7 cases of distal humeral fractures (7 elbows), and 4 cases of elbow tuberculosis (4 elbows). For each group, we recorded the operative time, intraoperative bleeding, elbow flexion, extension, pronation, supination, postoperative complication rates, and Mayo Elbow Performance Score after surgery. Operative time and intraoperative bleeding were less in group A than in group B (53-120 min [70 (62.5, 78) min] vs. 64-105 min [77 (73, 87) min], and 10-200 ml [50 (20, 90) ml] vs. 5-250 ml [100 (50, 150) ml], P <.028). The elbow flexion, pronation activity, and Mayo Elbow Performance Score were higher in group A than in group B, [(121 ± 12)° vs. (112 ± 10)°, 85 (85,85)° vs. 80 (77,85)°, and (94 ± 3) points vs. (91 ± 4) points, P <.036], while elbow extension and supination activity and complication rates were not statistically significant in either group. Compared to Bryan-Morrey approach, the olecranon osteotomy approach to TEA provides adequate visualization, saves operative time and reduces bleeding, provides better flexion activity, effectively improves elbow function, and achieves satisfactory clinical outcomes. [ABSTRACT FROM AUTHOR]

Studies have shown that percutaneous nerve stimulation can promote repair of ulnar neuropathy. However, this approach requires further optimization. We evaluated multielectrode array-based percutaneous nerve stimulation for treatment of ulnar nerve injury. The optimal stimulation protocol was determined using a multi-layer model of the human forearm using the finite element method. We optimized the number and distance between electrodes, and used ultrasound to aid in electrode placement. Six electrical needles in series along the injured nerve at alternating distances of five and seven centimeters. We validated the model in a clinical trial. Twenty-seven patients were randomly assigned to a control group (CN) and an electrical stimulation with finite element group (FES). The results showed that disability of arm shoulder and hand (DASH) scores decreased and grip strength increased to a greater extent in the FES group than those in the CN group following treatment ( $\text{P}< 0.05$ ). Furthermore, the amplitudes of compound motor action potentials (cMAPs) and sensory nerve action potentials (SNAPs) improved in the FES group to a greater extent than those in the CN group. The results showed that our intervention improved hand function and muscle strength, and aided in neurologic recovery, as shown using electromyography. Analysis of blood samples indicated that our intervention may have promoted conversion of the precursor form of brain-derived neurotrophic factor (pro-BDNF) to mature brain-derived neurotrophic factor (BDNF) to promote nerve regeneration. Our percutaneous nerve stimulation regimen for ulnar nerve injury has potential to become a standard treatment option.

Abstract Background Supracondylar humeral fractures (SCHFs) are frequent in children, and closed reduction with percutaneous pin fixation remains the standard surgical treatment for displaced SCHFs. Two pinning configurations, medial–lateral crossed entry pinning (MLP) and lateral-only entry pinning (LP), are widely used, but which one is superior to another one is still debatable. This meta-analysis aimed to compare the efficacy and safety of both pinning fixation methods. Methods Randomized controlled trials (RCTs) were searched on PubMed, EMBASE, Web of Science, Cochrane library and Google Scholar. Relative risk (RR) and mean difference (MD) with corresponding 95% confidence interval (CI) were calculated for radiographical outcomes, functional outcomes and complications. Results A total of 19 RCTs comprising 1297 Gartland type II and type III fractures were included. MLP had a decreased risk of loss of reduction (RR = 0.70, 95%CI 0.52–0.94, P = 0.018) but a higher risk of iatrogenic ulnar nerve injury (RR = 2.21, 95%CI 1.11–4.41, P = 0.024) than LP. However, no significant difference was observed for incidence of ulnar nerve injury if applying a mini-open technique in MLP group (RR = 1.73, 0.47–6.31, P = 0.407). There were no differences between both groups in loss of carrying angle (MD = − 0.12, 95%CI − 0.39 to 0.16), loss of Baumann angle (MD = 0.08, 95%CI − 0.15 to 0.30), excellent grading of Flynn criteria (RR = 1.06, 95%CI 0.99–1.14, P = 0.102) and pin tract infection (RR = 0.92, 95%CI 0.50–1.70). Conclusions MLP is more effective in maintaining fixation, while LP is safer with respect to ulnar nerve injury. MLP with a mini-open technique reduces the risk of ulnar nerve lesion and is an effective and safe choice.

Peripheral nerve injuries remain a major medical problem worldwide and are associated with multiple causes, including gunshot wounds (GSWs), which are the second most common cause of brachial plexus injuries in peacetime and the main, or only, cause reported in wartime studies. The ulnar nerve (UN) is one of the most affected nerves. Peripheral nerve trauma may cause intense neuropathic pain, which is very difficult to control. Particularly UN gunshot injuries may impact individual daily life, as injuries to this nerve result in both sensory and motor deficits within the hand. We evaluated the improvement of neuropathic pain after surgical treatment in a consecutive series of 20 patients with UN injury due to GSWs. This single-center, retrospective, consecutive case series included 20 patients with UN injuries due to GSWs, who presented with excruciating neuropathic pain and underwent surgical treatment between 2005 and 2017. Of injuries, 13 occurred in the right upper limb (65%); 12 patients had a high UN injury (60%). Regarding associated injuries, 8 patients had bone injuries (40%), and 4 patients had arterial injuries (20%). A neuroma in continuity was detected in 8 cases (40%), and 4 patients (20%) had shrapnel lodged within the UN. All patients had severe neuropathic pain and functional deficit, with a mean visual analog scale score of 8.45 ± 1.4 and a mean reduction of 6.95 points 12 months after surgery; 10 patients (50%) had a British Medical Research Council score ≥M3. Surgery is an effective treatment for neuropathic pain from GSWs. Early isolated external neurolysis is associated with better pain management and functional outcomes postoperatively. [ABSTRACT FROM AUTHOR]

The existing literature has explored carpal tunnel syndrome (CTS) and determined that it could be a risk for coronary artery disease (CAD), but there has been little research comparing the relevance of CAD with other neuromuscular disorders (NMDs) to CTS. This case–control study explored the association between CTS, stenosing tenosynovitis (ST), and ulnar side NMDs and CAD. The study utilized data from Taiwan’s National Health Insurance Research Database, focusing on health insurance claims. Between January 2000 and December 2011, we employed the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes to identify 64,025 CAD patients as the case group. The control group consisted of an equal number of individuals without CAD, matched for age, sex, and index year of CAD. Logistic regression analysis was employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for each variable. Multivariate analysis, after adjusting for sociodemographic factors and comorbidities, revealed a significantly higher likelihood of a previous diagnosis of CTS in the CAD group compared to the comparison control group. However, neither ST nor the ulnar side NMDs had any statistical significance. These results indicated that median nerve injury, rather than other NMDs, may uniquely serve as a predisposing factor of CAD.

Background: Supracondylar humeral fractures (SCHFs) are frequent in children, and closed reduction with percutaneous pin fixation remains the standard surgical treatment for displaced SCHFs. Two pinning configurations, medial–lateral crossed entry pinning (MLP) and lateral-only entry pinning (LP), are widely used, but which one is superior to another one is still debatable. This meta-analysis aimed to compare the efficacy and safety of both pinning fixation methods. Methods: Randomized controlled trials (RCTs) were searched on PubMed, EMBASE, Web of Science, Cochrane library and Google Scholar. Relative risk (RR) and mean difference (MD) with corresponding 95% confidence interval (CI) were calculated for radiographical outcomes, functional outcomes and complications. Results: A total of 19 RCTs comprising 1297 Gartland type II and type III fractures were included. MLP had a decreased risk of loss of reduction (RR = 0.70, 95%CI 0.52–0.94, P = 0.018) but a higher risk of iatrogenic ulnar nerve injury (RR = 2.21, 95%CI 1.11–4.41, P = 0.024) than LP. However, no significant difference was observed for incidence of ulnar nerve injury if applying a mini-open technique in MLP group (RR = 1.73, 0.47–6.31, P = 0.407). There were no differences between both groups in loss of carrying angle (MD = − 0.12, 95%CI − 0.39 to 0.16), loss of Baumann angle (MD = 0.08, 95%CI − 0.15 to 0.30), excellent grading of Flynn criteria (RR = 1.06, 95%CI 0.99–1.14, P = 0.102) and pin tract infection (RR = 0.92, 95%CI 0.50–1.70). Conclusions: MLP is more effective in maintaining fixation, while LP is safer with respect to ulnar nerve injury. MLP with a mini-open technique reduces the risk of ulnar nerve lesion and is an effective and safe choice. [ABSTRACT FROM AUTHOR]

BackgroundRotation of the distal fragment often occurs in flexion-type supracondylar humerus fractures (SCHFs), potentially leading to ulnar nerve injury (UNI) and open reduction. We analyzed the correlation between the rotations and UNI or open reduction and then assessed the risk factors associated with these rotations.MethodsData of Wilkins type III lateral flexion SCHFs were collected over a 10-year time period (1 January 2012 to 31 December 2021) in Children's Hospital of Fudan University Anhui Hospital. We defined the rotation of the distal fragment on the coordinate axis as two types, IIIA (X-axis rotation) and IIIB (the rotation of both X- and Y-axes) on X-ray radiography. Demographic data, the incidence of the two-type rotation, odds ratios (ORs) of UNI and open reduction, and risk factors of the rotation of both X- and Y-axes were analyzed.ResultsTotally, 152 patients were found (50 with IIIA vs. 102 IIIB). The UNI rate was 13%, and the open reduction rate was 22%. The UNI rate of the IIIB was five-fold higher than that of the IIIA [OR, 5.143; 95% confidence interval (CI), 1.414–23.125; p = 0.019], and the open reduction rate of the IIIB was nearly five-fold higher than that of the IIIA (OR, 4.729, 95%CI, 1.584–14.495; p = 0.003). In these two types, patients with UNI had a higher risk of open reduction than those without UNI (OR, 9.816; 95%CI, 3.503–27.508; p = 0.001). In the multiple regression analysis, a high level of fracture was identified as a risk factor for the rotation of both X- and Y-axes.ConclusionType IIIB lateral flexion-type SCHFs have higher rates of UNI and open reduction, and a high level of fracture is a risk factor associated with this type.

Wenquan Ding,1,* Xueyuan Li,1,* Jiadong Pan,1 Peixun Zhang,2 Shanqing Yin,1 Xianting Zhou,1 Junjie Li,1 Liping Wang,1,3 Xin Wang,1 Jianghui Dong1,3 1Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, Ningbo 315040, People’s Republic of China; 2Department of Trauma Orthopedics, Peking University People’s Hospital, Beijing 100044, People’s Republic of China; 3School of Pharmacy and Medical Sciences, and UniSA Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia*These authors contributed equally to this workCorrespondence: Xin WangDepartment of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No.6 Hospital, Ningbo 315040, People’s Republic of ChinaTel/Fax +86574-87996193Email dr.wangxin@hotmail.comJianghui DongSchool of Pharmacy and Medical Sciences, University of South Australia, Adelaide SA 5001, AustraliaTel +618 8302 2715Fax +618 8302 1087Email Jianghui.dong@mymail.unisa.edu.auPurpose: Complete high ulnar nerve injury can cause serious sequelae, including residual sensation and loss of movement and especially dysfunction of the intrinsic muscles of the hand. As a solution to treat complete high ulnar nerve injury, we proposed a new repair method for ulnar nerve injury based on nerve-magnified regeneration.Methods: Twenty-two patients with complete division of the ulnar nerve at a high level who were treated from May 2013 to December 2016 were divided into two groups. The proposed repair method for complete high ulnar nerve injury was performed in group I (11 patients), while the traditional repair method, ie, repair of the original injury site of the ulnar nerve, was used in group II (11 patients).Results: The results showed no significant difference in the mean sensory scores assigned by the Highet-Zachary scheme (the Highet Scale) between the two groups. The mean Highet Scale score of muscle strength for the first dorsal interosseus muscle was significantly better in group I than that in group II (p=0.010). In group I, 10 of 11 patients were graded as M4 or M5. Grip strength, pinch strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were significantly better in group I than those in group II (p< 0.01).Conclusion: Therefore, this method for complete high ulnar nerve injury based on nerve-magnified regeneration can shorten the path of motor nerve regeneration, effectively reduce atrophy of the intrinsic muscles of the hand, and provide better hand function.Keywords: nerve magnified regeneration, ulnar nerve injury, nerve repair, peripheral nervous system

Objective: To assess the outcome of pediatric supracondylar humeral fractures managed by percutaneous lateral k-wire fixation. Location and Period: Orthopedics and Trauma Unit, MTI Khyber Teaching Hospital, Peshawar, KPK, Pakistan from August 2017 to July 2019. Material and Methods: This prospective case series comprised of forty pediatric supracondylar humeral fractures managed by percutaneous lateral k-wires fixation. Outcome was analyzed as excellent, good, fair and poor according to Flynn's criteria14 at final follow up (6 months). Results: Out of 40 children, 29 (72.5%) were boys and 11 (27.5%) were girls. Average age at the start of the study was 6.5±1.72(2SD) years. In 31 (77.5%) patients, left elbow was involved while in 9 (22.5%) of patients, right elbow was involved. 13 (32.5%) patients had type II while 27 (67.5%) patients had type III supracondylar humeral fracture according to Gartland's classification system. The average operating time in minutes was 46.38±6.46 SD. All fractures united in 4-6 weeks time. 71.43% patients showed excellent outcome, 22.86% patients showed good outcome while 5.71% patients showed fair outcome. No case of poor outcome was seen. Apart from pin tract infection in 3 patients, no other post-operative complications were reported. Not a single patient required additional surgery. Conclusion: Percutaneous lateral k-wire fixation for managing pediatric displaced supracondylar humeral fractures had excellent outcome in most of our patients. We consider lateral pinning technique as a method of choice with the benefit of providing adequate mechanical stability and almost no chance of ulnar nerve injury. Further randomized controlled trials comparing lateral versus cross pinning techniques may be carried out to confirm our results. [ABSTRACT FROM AUTHOR]

Background: Plate and screw fixation during the treatment of distal humeral fracture in adults is considered to be a gold standard that makes anatomic and articular reduction. Injury of the ulnar nerve is a common condition that can be found in pre-operative, intraoperative, and postoperative. Intraoperative anterior subcutaneous transposition is still a controversial issue. Objective: To understand the variation of distance of the ulnar nerve during elbow motion with the anatomical landmark of distal humeral bone and plate position after fixation. Materials and Methods: The authors have studied ten fresh adult cadavers, who underwent autopsy at the Department of Forensic Medicine of Srinakharinwirot University. Results: The results showed that in zone 2, the Center of the medial condyle was the position of the distal humeral bone with the most variation in position changing during elbow flexion/extension. In the sagittal plane (+2.56 to -4.58 mm), the mean difference equaled to 7.14 mm, while in the coronal plane (+1.70 to -5.14 mm), the mean difference equaled to 6.84 mm, with the highest percentage of irritation up to 70%. Furthermore, 14 cases of ulnar nerve subluxation were found in 20 studies (70%). Conclusion: From the present study, the Medial condyle was the landmark with the most irritation and position changing of ulnar nerve during elbow flexion. The incidence of ulnar subluxation occurred after in situ release for plate fixation was also found higher than in previous studies. [ABSTRACT FROM AUTHOR]

Background:  Supracondylar humeral fractures are the most prevalent elbow fractures in pediatric patients. Current treatment modalities typically involve closed reduction and fixation using percutaneous Kirschner wires. The lateral cross-wiring technique has demonstrated favorable functional and cosmetic outcomes, thereby reducing the incidence of ulnar nerve injury., Objectives:  This study aimed to assess the efficacy of the lateral cross-wiring technique in achieving optimal functional and cosmetic recovery while mitigating the risk of ulnar nerve injury in pediatric patients with displaced supracondylar humeral fractures., Materials and Methods: A prospective analysis was conducted on 48 patients who underwent lateral cross-wiring for displaced supracondylar fractures (Gartland type III, including extension and flexion types) of the humerus. Follow-up assessments were performed over a minimum period of eight months post-surgery., Results: Among the 48 patients, all demonstrated satisfactory restoration of the carrying angle and functional ability postoperatively. Notably, no iatrogenic cases of radial or ulnar nerve injury were observed during the follow-up period., Conclusion:  The lateral cross-wiring technique emerges as an effective treatment option for displaced supracondylar fractures of the humerus in pediatric patients. It facilitates both functional and cosmetic recovery while concurrently reducing the risk of ulnar nerve injury, thus warranting consideration in the management of such fractures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Phan et al.)

Introduction: Supracondylar humerus fractures are the most common elbow injuries in children. The widely adopted approach for Gartland III extension type consists of closed reduction and percutaneous pinning; the pin configuration can be lateral or crossed in relationship with the habit of the surgeons. Iatrogenic injury of the ulnar nerve is the most common risk during the insertion of the medial pin. The aim of this study was to analyze advantages and disadvantages of percutaneous pinning with the patient in prone position.Materials and Methods: A literature review of the period 2005-2017 was carried out; four medical search engine (Pubmed, Cochrane Library, ISI Web of Science and Scopus) were consulted using the review's filter and the key words "Ulnar nerve AND supracondylar humerus fractures". The total number of patients were analyzed for: ulnar nerve injuries, anesthesiologic management, time of surgery.Results: Twenty-nine papers were read, 23 regarding cross pinning in supine position and 6 in prone position. On one hand, 1529 children were treated with closed reduction and cross pinning in supine position; 69 of these patients (4.5%) suffered from iatrogenic ulnar nerve injury. On the other hand, 579 patients underwent the same treatment in prone position; no ulnar nerve lesions were reported in this group. Only one article compared both groups of children in supine and prone position regarding time of anesthesia which is slightly higher in the prone group. There were no differences between supine and prone positions regarding x-ray exposition, time of surgery, closed reduction manoeuvers, pin positioning, x-ray results, clinical and functional results.Discussion and Conclusions: The ulnar nerve in children is hypermobile in the cubital tunnel and tends to dislocate anteriorly over the medial epicondyle, especially when the elbow is in hyperflexion. This may be the reason of the increased risk of nerve injury during the insertion of the medial pin in supine position and, instead, an advantage of the prone position. The insertion of both pins from the lateral side could reduce this complication. Larger studies need to be carried out regarding the reported higher duration of anesthesia in prone position. [ABSTRACT FROM AUTHOR]

Background: Sparse documentation of Galeazzi fracture with associated nerve injury exists in the medical literature. The purpose of this report is to review the available literature in regard to incidence, nerve injury type, treatment strategies, and expected outcomes. Methods: We present a classic Galeazzi fracture dislocation with associated complete ulnar nerve transection injury at the level of the wrist. After rigid internal bony stabilization, allograft nerve repair was performed. The patient's presentation, operative management, recovery, and a thorough literature review are discussed. Results: Fracture union was attained with near full wrist and elbow range of motion. Despite lack of ulnar nerve function return, the patient was able to resume manual labor occupation. Conclusions: Despite its close proximity to the dislocating distal radioulnar joint (DRUJ), thorough review reveals rare associated ulnar nerve palsy. If there is suspicion for nerve injury in the setting of open DRUJ dislocation, the nerve should be explored to identify possible entrapment or transection. Literature supports likely return of nerve function in cases of intact nerve; however, management of nerve transection remains debatable. [ABSTRACT FROM AUTHOR]

Purpose To assess the efficacy of nerve transfer versus nerve grafting in restoring motor and sensory hand function in patients with complete, isolated high ulnar nerve injuries. Methods A retrospective chart review was performed, at a minimum 2 years of follow-up, of 52 patients suffering complete, isolated high ulnar nerve injury between January 2006 and June 2013 in one specialized hand surgery unit. Twenty-four patients underwent motor and sensory nerve transfers (NT group). Twenty-eight patients underwent sural nerve grafting (NG group). Motor recovery, return of sensibility and complications were examined as outcome measures. The Medical Research Council scale was applied to evaluate sensory and motor recovery. Grip and pinch strengths of the hand were measured. Results Twenty of 24 patients (83.33%) in the NT group regained M3 grade or greater for the adductor pollicis, the abductor digiti minimi, and the medial 2 lumbricals and interossei, compared with only 16 of 28 patients (57.14%) in the NG group. Means for percentage recovery of grip strengths compared with the other healthy hand were significantly higher for the NT group than the NG group. Sensory recovery of S3 or greater was achieved in more than half of each group with no significant difference between groups. Conclusions Nerve transfer is favored over nerve grafting in managing high ulnar nerve injuries because of better improvement of motor power and better restoration of grip functions of the hand. Type of study/level of evidence Therapeutic IV. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective cohort study. Introduction: Some patients after median or ulnar nerve injury report a diminished sensibility in the hngers that are supplied by the uninjured nerve. Purpose of the Study: The purpose of this study was to evaluate the function of the uninjured nerve in pabents after peripheral nerve injury to assess the presence and degree of its functional impairment Methods: There were 28 patients with median and 29 patients with ulnar nerve injury examined for sensory disturbances in the injured and uninjured nerves, using several tests assessing touch temperature, and vibration sensibility. Results. In 16 patients after ulnar and 13 patients after median nerve injury, some disturbances in the uninjured nerve were found, mostly in individual tests. Only 8 patients had 3 or more different tests abnormal Discussion: The injured nerve function in patients with functional disturbances in the uninjured nerve was worse than in patients with normal test results. Conclusion: Posttraumatic changes in central nervous system are the possible reasons. Level of Evidence: Level 111 study. [ABSTRACT FROM AUTHOR]

In adolescents, neurovascular injury, especially ulnar nerve injury, is rare with fracture of the distal radius. We present a 14-year-old boy who sustained fracture of the distal radius in his right wrist, who also had symptoms of ulnar nerve injury. Close reduction with percutaneous pinning and cast to fix the distal radius fracture was done immediately. Then, we decided to observe the recovery of the nerve injury without providing any emergent nerve exploration. Bone union was achieved after 8 weeks of fixation, and the function of the ulnar nerve was restored completely after 16 weeks of observation. The possibility of ulnar nerve injury should be considered following fracture of the distal aspect of the radius, and we recommend observing the recovery of nerve injury, with no need for emergent nerve exploration.

Objective: This study illustrates that direct electrical stimulation (ES) improve functional recovery and time of return to work evaluated by prognostic scoring system after ulnar nerve injury.Design: The Rosén and Lundborg (R&L) protocol, Disabilities of the Arm, Shoulder and Hand (DASH) scores, and electromyography were applied for measuring improvements after direct ES intervention.Setting: A 32-year-old male with deep cutting wound and total rupture of right proximal forearm ulnar nerve was treated using direct ES and daily rehabilitation activities.Intervention: Direct ES, transmitted using 2 acupuncture needles inserted in the cubital tunnel, was applied along the site of the injured ulnar nerve. Other needles were placed according to muscle origins and insertions. All needles were connected to electrical stimulators. We executed these procedures once per week and conducted rehabilitating activities daily.Main Outcome Measures: The R&L protocol, DASH scores, and electromyography were used to measure the intervention outcomes.Results: The total score in the R&L protocol was 0.703 of the initial state; the sensory domain contributed the least amount. Among the improved numerical factors, pain/discomfort domain was the first to reach a stable ameliorative state in the first month. The sensory and motor domains reached stable growth in fourth and third months, respectively. The patient returned to the previous job in third month; his time off work was 75 days.Conclusions: Directly applying ES to the proximal site of an injured nerve can augment nerve regeneration through three suspected mechanisms. Although direct ES on the injured nerve contributed to an effective recovery of this patient with minimal adverse effects, additional investigation of treatment protocols is warranted and the actual mechanism must be identified. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the effectiveness and feasibility of movement therapy induced by modified constraint on the upper limb of patients with ulnar nerve injuries. The study uses box and block test and administered assessments for baseline, intervention and withdrawal phase randomly. Results show that the use of movement therapy induced by modified constraint in the rehabilitation of patients is feasible and needed further research.

Purpose: The aim of the study was to evaluate the results of epiperineural suture repaired primary (clean transaction injury, massive soft-tissue associated injury) and secondary (delayed partial injury) ulnar nerve injuries according to lesion level and type. Methods: Forty-two patients diagnosed with ulnar nerve injury between January 2008 and January 2012 were involved in the study. Ulnar nerve lesions were classified according to the level of injury into three types: type 1-lesion located above the flexor carpi ulnaris branch; type 2-lesion located between the flexor carpi ulnaris and the flexor digitorum profundus III and IV; type 3-lesion located below the flexor digitorum profundus III and IV and no more than 10 cm distal from the elbow crease. Additionally, ulnar nerve lesions were classified according to type into three groups: group 1 ( n 17)-clean transaction injury; group 2 ( n 14)-massive soft-tissue associated injury; group 3 ( n 11)-delayed partial clean transaction injury. In follow-up evaluations, sensory and motor recovery was analysed with the most common Highet scale modified by Dellon et al. Functional results were evaluated according to the Disability of Arm, Shoulder, and Hand (DASH) score at final follow-up. Results: There were no statistically significant differences between groups according to men/women ratio, mean age, mean follow-up period and ulnar-nerve injury level. The DASH score was significantly better in the clean transaction injury group than the other groups and significantly better for type 3 than types 1 and 2 injuries in all groups. Sensory recovery of type 1 and 3 injuries in the massive soft-tissue associated injury group was significantly worse than the other groups. The worst motor recovery was evaluated in type 1 injury and the best in type 3 injury according to injury level. According to group, motor recovery of the massive soft-tissue associated group was significantly worse than the other groups in all injury types. There were no statistically significant differences between clean transaction injury and delayed partial clean transaction injury groups in all injury types. Conclusions: Prognostic factors that influenced motor-sensory recovery and functional results were found in interval between trauma and reconstruction, injury level (worse results from proximal to distal) and mechanism of injury (worse results from massive soft-tissue injury to clear, sharp-tissue injury). [ABSTRACT FROM AUTHOR]

Background: Rotation of the distal fragment often occurs in flexion-type supracondylar humerus fractures (SCHFs), potentially leading to ulnar nerve injury (UNI) and open reduction. We analyzed the correlation between the rotations and UNI or open reduction and then assessed the risk factors associated with these rotations., Methods: Data of Wilkins type III lateral flexion SCHFs were collected over a 10-year time period (1 January 2012 to 31 December 2021) in Children's Hospital of Fudan University Anhui Hospital. We defined the rotation of the distal fragment on the coordinate axis as two types, IIIA ( X -axis rotation) and IIIB (the rotation of both X - and Y -axes) on X-ray radiography. Demographic data, the incidence of the two-type rotation, odds ratios (ORs) of UNI and open reduction, and risk factors of the rotation of both X - and Y -axes were analyzed., Results: Totally, 152 patients were found (50 with IIIA vs. 102 IIIB). The UNI rate was 13%, and the open reduction rate was 22%. The UNI rate of the IIIB was five-fold higher than that of the IIIA [OR, 5.143; 95% confidence interval (CI), 1.414-23.125; p = 0.019], and the open reduction rate of the IIIB was nearly five-fold higher than that of the IIIA (OR, 4.729, 95%CI, 1.584-14.495; p = 0.003). In these two types, patients with UNI had a higher risk of open reduction than those without UNI (OR, 9.816; 95%CI, 3.503-27.508; p = 0.001). In the multiple regression analysis, a high level of fracture was identified as a risk factor for the rotation of both X - and Y -axes., Conclusion: Type IIIB lateral flexion-type SCHFs have higher rates of UNI and open reduction, and a high level of fracture is a risk factor associated with this type., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sun, Shan, Meng, Liu, Wang and Jia.)

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We report here the management of glass fragment buried in the soft tissue close to the ulnar nerve. Also discuss how ultrasound provides real-time guidance without radiation exposure and emphasize the importance of this evolving and exciting imaging field.

High ulnar nerve injuries frequently result in poor functional recovery. The prolonged denervation of target muscle largely accounts for the poor functional outcome. There are no approved effective treatments for high ulnar nerve injuries. However, the technique of reverse end-to-side (RETS) offers novel possibilities. The RETS nerve transfer not only provides earlier motor end-plate reinnervation to 'babysit' the target muscle until native axons from the original high nerve regenerate, but also augments the regenerating axons. We postulate that coaptation of anterior interosseous nerve to the side of distal ulnar nerve by RETS technique could be an effective therapeutic intervention for high ulnar nerve injuries in human. [ABSTRACT FROM AUTHOR]

Background  There has been an increasing utilization of end-to-end (ETE) and reverse "supercharged" end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar nerve transfers (NTs) for treatment of high ulnar nerve injury. This study aimed to review the potential indications for, and outcomes of, ETE and SETS AIN-ulnar NT. Methods  A literature review was performed, and 10 articles with 156 patients who had sufficient follow-up to evaluate functional outcomes were included. English studies were included if they reported the outcome of patients with ulnar nerve injuries treated with AIN to ulnar motor NT. Outcomes were analyzed based on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, grip and key pinch strength, and interosseous Medical Research Council-graded motor strength. Comparisons were made using the independent t -test and the chi-square test. No nerve graft control group was required for eligibility. Ulnar nerve injury types varied. Results  NT resulted in 77% of patients achieving M3+ recovery, 53.7 ± 19.8 lb grip strength recovery, 61 ± 21% key pinch recovery, and a mean DASH score of 33.4 ± 16. In this diverse group, NT resulted in significantly greater M3+ recovery and grip strength recovery measured in pounds than in the nerve graft/conventional treatment group, and ETE repairs had significantly better outcomes compared with SETS repairs for grip strength, key pinch strength, and DASH scores, but heterogeneity limits interpretation. Conclusion  ETE and SETS AIN-ulnar NTs produce significant restoration of ulnar nerve motor function for high ulnar nerve injuries. For ulnar nerve transection injuries at or above the elbow, ETE NT results in superior motor recovery compared with nerve grafting/conventional repair. However, further research is needed to determine the best treatment for other types of ulnar nerve injury and the role of SETS NT., Competing Interests: Conflict of Interest None declared., (Society of Indian Hand Surgery & Microsurgeons. All rights reserved.)

Fracture of the radial neck are uncommon injuries. In children, they may present as radial neck fractures, a components of forearmfracture dislocations, or as isolated fracture dislocations. Here, we present an unusual and previously undescribed variant of radialneck fracture with dislocation of the radial head to the medial side and ulnar nerve injury. The fracture dislocation was openlyreduced and fixed with a small fragment plate. The fracture healed with some loss of rotational movements. At short followup of6 months patient had useful elbow function but ulnar nerve did not recover. [ABSTRACT FROM AUTHOR]

This report presents a case of direct injury to the dorsal sensory branch of the ulnar nerve caused by arthroscopic repair of the triangular fibrocartilage complex. The dorsal sensory branch of the ulnar nerve was strangulated by one of the three pull-out sutures of the joint capsule, just ulnar to the extensor carpi ulnaris tendon. Pain and dysaesthesia of the ulnar side of the wrist was completely relieved after excision of the injured nerve segment. This complication can be avoided by careful exploration of the dorsal sensory branch of the ulnar nerve prior to suturing or passage of instruments during arthroscopy. [Copyright &y& Elsevier]

A patient with a traumatic ulnar nerve interruption at the level of the elbow is presented; the motor function of the hand remained intact. Electromyographic studies demonstrated a functional median-to-ulnar motor nerve anastomosis in the forearm. The literature on this aberration of innervation is reviewed, and problems of diagnosis and the treatment are discussed. [ABSTRACT FROM AUTHOR]

Background: Supracondylar humerus fractures are one of the most common fractures in children .Closed reduction under general anesthesia and placement of 2 or more wire from lateral side is the most commonly performed procedure. The objective of this study was to determine the outcome of lateral only pins in the operative management of supracondylar fractures in children as compared to cross pinning. Materials & Methods: This study was conducted in orthopedic and trauma department of Fauji Foundation Hospital Peshawar w.e. f June 2015 to December 2016. Children with gartland type II and III closed injuries without neurovascular compromise were included in the study. Outcome was measured in terms of ulnar nerve symptoms, non-union and varus mal-alignment. RESULT: A total of 39 patients were included in the study, 22(56%) were type II and 17(44%) were type III fractures. Out of total type II fractures 17(77%) were managed with lateral only pinning and 5(23%) needed a medial pin as well. Of the type III fractures 10(59%) were managed by lateral pinning and 7(41%) by cross pin pattern. On final follow up no non-union, versus misalignment or ulnar nerve deficit was observed. Conclusion: Lateral pin fixation has eliminated the risk of iatrogenic ulnar nerve injury with comparable clinical outcome to cross K- wire fixation. [ABSTRACT FROM AUTHOR]

Background: Symptomatic non-union of medial humeral epicondylar fractures is a limited entity. Some studies recommend surgical excision of the fragment, but the results are controversial. The purpose of this study is to evaluate the outcome of open reduction and internal fixation of a medial epicondyle non-union fragment.Materials and Methods: A retrospective study was conducted in all the patients, who were operated in our hospital between the year 2010 and 2015 for symptomatic medial humeral epicondyle non-union. Inclusion criteria were open reduction and internal fixation of symptomatic medial epicondyle non-union and minimum one year of follow-up from time of surgery. Exclusion criteria included other associated musculoskeletal disorders of the affected limb. Open reduction and internal fixation of the fragment was done in all patients and the ulnar nerve was decompressed and anteriorly transposed in cases where symptomatology was present. Outcome was assessed with radiograph, range/arc of motion, Visual analogue pain scoring and two functional outcome tools.Results: Study sample consisted of 14 patients, with mean age at presentation of 14.9 years (range 6 to 50 years) with mean time since injury of 7.7 months (range 3 to 24 months). Patients presented with medial elbow pain and prominence, limited range of motion, valgus instability, and ulnar nerve compression. After open reduction and internal fixation, at a mean of three years after surgery (range 1.5 to 5 years), patients reported an improvement in visual analogue pain score from a mean of 7.29±1.3 to 0.21±0.4, and the difference was statistically significant (p=0.001). Mean postoperative Quick DASH (Disability of Arm, Shoulder, and Hand) score was 5.21±7.2. Mean Mayo Elbow Performance Score was 96.7±6.1. Improvement in arc of motion was statistically significant (p=0.001). Radiographic union was achieved in all patients except one who had fibrous union. Functional elbow range of motion was achieved in 13 out of 14 cases (92.8%) and ulnar nerve recovered in five patients and one patient required tendon transfer.Conclusion: Open reduction and internal fixation of symptomatic medial humeral epicondyle non-union gives excellent clinical and functional outcome in the majority of cases. [ABSTRACT FROM AUTHOR]

We report here the management of glass fragment buried in the soft tissue close to the ulnar nerve. Also discuss how ultrasound provides real-time guidance without radiation exposure and emphasize the importance of this evolving and exciting imaging field. [ABSTRACT FROM AUTHOR]

Peripheral nerve injuries are challenging problems. Nerve transfers are one of many options available to surgeons caring for these patients, although they do not replace tendon transfers, nerve graft, or primary repair in all patients. Distal nerve transfers for the treatment of high ulnar nerve injuries allow for a shorter reinnervation period and improved ulnar intrinsic recovery, which are critical to function of the hand., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Supracondylar humerus fractures are common in children. Displaced fractures are usually treated with closed reduction and cross pin fixation. But, medial pinning may cause the ulnar nerve injury. The aim of this study was to compare the parents-based cosmetic satisfaction of the incision scars in children with displaced supracondylar humerus fractures treated by closed reduction and cross pin fixation with or without small medial incision. We retrospectively reviewed the medical records of 72 children with displaced supracondylar humerus fractures treated two different closed reduction and percutaneous pinning methods at our institution from January 2010 through December 2013. A group has 36 patients treated with small medial incision and crossed K-wires fixation after closed reduction. The other group has 36 patients treated with closed reduction and K-wires fixation. At the final follow-up, the patients were evaluated radiologically and clinically with Flynn's criteria. Furthermore, a visual analogue scale was used to determine of the parents-based cosmetic satisfaction score. All fractures healed without major complications at the final clinical and radiological assessment. Although, between the two groups did not differ in terms of Flynn cosmetic and functional outcomes, there were statistically significant differences between both groups according to the parents-based cosmetic satisfaction scores. The closed reduction and crossed pin fixation without small medial incision should be preferred first because of better the parents-based cosmetic satisfaction.