OBJECTIVE: To discuss the elbow skin fold extension line in Kirschner wire internal fixation of extended supracondylar humeral fractures in children. METHODS: The clinical data of 58 children with extended supracondylar fractures of the humerus who met the selection criteria between August 2021 and July 2024 were retrospectively analyzed. In 28 cases, needle placement of medial epicondyle of humerus was performed with the assistance of the elbow skin fold extension line (study group), and 30 cases were assisted by routine touch of the medial epicondyle of the humerus (control group). There was no significant difference in baseline data such as gender, age, side, cause of injury, Gartland type, Kirschner wire configuration, and time from injury to operation between the two groups ( P>0.05). The closed reduction rate, total operation time, time of medial humeral condyle pin placement, fluoroscopy times during medial pin placement, rate of one-time determination of medial entry point, ulnar nerve injury incidence, and fracture healing time were recorded and compared between the two groups. At the same time, the closed reduction rate of patients with the time from injury to operation ≤24 hours and >24 hours was compared. The elbow function was evaluated by Mayo elbow function score. RESULTS: The closed reduction rate of the study group was significantly higher than that of the control group ( P<0.05). Among all patients, the closed reduction rate of patients with the time from injury to operation ≤24 hours [73.3% (22/30)] was significantly higher than that of patients >24 hours [42.9% (12/28)] ( χ ²=5.545, P=0.019). The total operation time, medial needle placement time, and fluoroscopy times in the study group were significantly less than those in the control group, and the one-time determination rate of medial needle entry point in the study group was significantly higher than that in the control group ( P<0.05). There were 4 cases of ulnar nerve injury in the control group, and no ulnar nerve injury in the study group, but there was no significant difference in the incidence of ulnar nerve injury between the two groups ( P>0.05). All patients were followed up 6-12 months (mean, 8 months). There was no bone nonunion in both groups, and the fracture healing time of the study group was significantly shorter than that of the control group ( P<0.05). Volkmann ischemic contracture, heterotopic ossification, myositis ossificans, and premature epiphyseal closure were not observed after operation. No complications such as loosening or fracture of Kirschner wire occurred. At last follow-up, the Mayo elbow joint function score was used to evaluate function, and there was no significant difference between the two groups ( P>0.05). CONCLUSION In the treatment of extended supracondylar fractures of the humerus in children, the elbow skin fold extension line can help to quickly locate the medial epicondyle of the humerus, quickly insert Kirschner wire, and reduce the operation time and trauma.
Humans ; Humeral Fractures/surgery* ; Bone Wires ; Male ; Female ; Fracture Fixation, Internal/instrumentation* ; Retrospective Studies ; Child ; Elbow Joint/physiopathology* ; Child, Preschool ; Treatment Outcome ; Fracture Healing ; Ulnar Nerve/injuries* ; Adolescent ; Range of Motion, Articular

INTRODUCTION: The cross Kirschner wire (K-wire) configuration in closed reduction and percutaneous pinning of paediatric supracondylar humeral fracture affords superior stability. However, medial pin placement presents a risk of iatrogenic ulnar nerve injury. This study describes, in step-by-step detail, another safe method of percutaneous medial pin insertion. METHODS: The technique involved placing the patient's arm in external rotation, with elbow flexed no more than 45° after closed reduction. The surgeon held the K-wire close to its sharp end to pass it percutaneously onto the medial epicondyle, then adjusted his grip toward the blunt end. After fluoroscopy check, the wire driver was engaged and an anteriorly directed force was applied to the distal humerus fragment using the thumb of the surgeon's free hand. The K-wire was inserted at a 45° angle to the longitudinal axis of the humerus shaft. Clinical notes and radiographs of patients who underwent surgery with this technique from 2006 to 2008 were reviewed. RESULTS: A total of 125 patients (84 boys, 41 girls) were included, with a mean age of 7.1 (range 2-14) years. Most injuries were left-sided (72.8%, n = 91, vs. right: 27.2%, n = 34). 72 (57.6%) patients had two-pin cross K-wire configuration, while 53 (42.4%) patients had an additional lateral pin inserted. No patient had postoperative ulnar neuropathy. There were no complications of non-union, malunion or infection. CONCLUSION This safe method of medial pin placement for surgical stabilisation of paediatric supracondylar humeral fractures is easily learnt and reproducible, and produces excellent results.
Adolescent ; Bone Nails ; Child ; Child, Preschool ; Female ; Fluoroscopy ; Fracture Fixation, Intramedullary ; methods ; Humans ; Humeral Fractures ; surgery ; Humerus ; injuries ; Iatrogenic Disease ; Male ; Pediatrics ; Radiography ; Retrospective Studies ; Ulnar Nerve

In the evaluation of peripheral nerve injury, nerve conduction studies and needle electromyography mainly focus on anatomical localization and functional evaluation of lesions. Whereas neuromuscular ultrasound has an advantage in structural assessment of lesions. In addition, muscle ultrasound can also be used to demonstrate muscle denervation without causing pain. We report a case of traumatic ulnar nerve injury at hand in which muscle ultrasound contributed to precise localization by provided detailed information about the extent of muscle denervation.
Electromyography ; Hand ; Humans ; Muscle Denervation ; Needles ; Neural Conduction ; Neuroanatomy ; Peripheral Nerve Injuries ; Peripheral Nerves ; Ulnar Nerve ; Ulnar Neuropathies ; Ultrasonography

The reported cases of upper limb nerve injury followed by needle procedure such as intramuscular injection or routine venipuncture are rare. However, it should not be overlooked, because neurological injury may cause not only minor transient pain but also severe sensory disturbance, hand deformity and motor dysfunction with poor recovery. Recognizing competent level of anatomy and adept skill of needle placement are crucial in order to prevent this complication. If a patient notices any experience of abnormal pain or paresthesia during the needle procedures, an administrator should be alert to the possibility of nerve injury and should withdraw the needle immediately. Careful monitoring of the injection site for hours is required for early detection of nerve injury.
Administrative Personnel ; Catheterization, Peripheral ; Hand Deformities ; Humans ; Injections, Intramuscular* ; Median Neuropathy ; Needles ; Paresthesia ; Peripheral Nerve Injuries ; Phlebotomy* ; Radial Neuropathy ; Ulnar Neuropathies ; Upper Extremity*

Accessory Nerve ; transplantation ; Birth Injuries ; complications ; surgery ; Brachial Plexus Neuropathies ; etiology ; surgery ; Child, Preschool ; Early Medical Intervention ; Elbow ; Humans ; Infant ; Intercostal Nerves ; transplantation ; Nerve Transfer ; methods ; Radial Nerve ; surgery ; Sural Nerve ; transplantation ; Time Factors ; Treatment Outcome ; Ulnar Nerve ; transplantation

Although the musculoskeletal injuries associated with break-dancing which is gaining more popularity among adolescent and young people has been reported, the report regarding a peripheral nerve injury associated with breakdance is scarce. We report a rare case of a young amateur break-dancer, 'b-boy' who suffered from a painful paresthesia in his left hand, later diagnosed as type III Guyon's canal syndrome. A 23-year-old, right handed college man presented with a tenderness over the left hypothenar eminence and painful paresthesia over the ring and little fingers of 3 months duration. He trained himself as an amateur 'b boy' break-dancer for the last 10 months. Conservative management under the diagnosis of wrist sprain before presentation did not improve his hand pain. An magnetic resonance imaging and electrodiagnostic study revealed that painful paresthesia was caused by type III Guyon's canal syndrome, and 4 weeks of corticosteroid treatment was given with resolution of pain and paresthesia.
Adolescent ; Athletic Injuries ; Diagnosis ; Fingers ; Hand ; Humans ; Magnetic Resonance Imaging ; Paresthesia ; Peripheral Nerve Injuries ; Sprains and Strains ; Ulnar Nerve ; Ulnar Nerve Compression Syndromes* ; Wrist ; Young Adult

Total elbow arthroplasty was initially used to manage the rheumatoid arthritis of elbow. With the developement of technology in recent decades, the indication of total elbow arthroplasty include the trauma associated unstable joint, traumatic arthritis and distal humerus fractures in elderly. But the high risk of complications, which includes infection, ulnar nerve deficit and tricep insufficiency, is still an unsolved issue. The most widely used approach nowadays is the Bryan-Morrey approach, while some authors also report triceps on approach recently. This article is an overview in approaches and biomechanical researches of total elbow arthroplasy by reviewing the domestic and overseas involved literatures.
Arthroplasty, Replacement, Elbow ; adverse effects ; methods ; Humans ; Muscles ; physiopathology ; Recovery of Function ; Ulnar Nerve ; injuries

OBJECTIVE: To estimate the application of prognosis evaluation of ulnar nerve injury by 1H-magnetic resonance spectroscopy (1H-MRS). METHODS: The metabolites of first dorsal interossei (FDI) of two hands from 12 healthy volunteers and 1 volunteer with complete ulnar nerve injury were detected by 1H-MRS and the data were statistically analyzed. RESULTS: For the FDI of healthy adults, the female peaks area of extra-myocellular lipids (EMCL) was higher than the male (P < 0.05); There was no significant difference in Cho, Cr and intra-myocellular lipids (IMCL) between male and female (P > 0.05); There was no significant difference in all the peaks area between the left and right hand (P > 0.05). The EMCL peak of the injury side was higher than that of the healthy side, and the area of FDI was reduced in the volunteer with ulnar nerve injury. CONCLUSION Noninvasive and quantitative detection of 1H-MRS may be valuable for prognosis evaluation of peripheral nerve injury.
Adult ; Female ; Humans ; Male ; Peripheral Nerve Injuries/diagnosis* ; Prognosis ; Proton Magnetic Resonance Spectroscopy/methods* ; Sex Distribution ; Ulnar Nerve/metabolism*

BACKGROUND: Nerve conduction study(NCV) in elderly patients is considered as a useful diagnostic tool for elderly patients with peripheral neuropathy. OBJECTIVE: Here the author investigates parameters of NCV in elderly Hansen patients out of Sorokdo hospital and compares them with those of healthy elders. METHODS: The author enrolled 28 patients who were visiting OPD for surgical wound care. Out of them 8 patients were dropped off because of hypersensitive response to the test stimulation or having failed to attatch the electrodes on severely deformed hands and fingers. Consequently parameters of NCV such as latency, amplitude, and conduction velocity in upper extremities of 20 patients were investigated and compared with those of healthy elders at similar age range. RESULTS: The patients were 12 in male and 73 years old on the average. In sensory nerve study, the parameters for median nerve showed 5.52+/-3.5msec in latency, 23.01+/-16.71uV in amplitude, and 29.03+/-13.16m/s in conduction velocity. For ulnar nerve, 5.82+/-3.76, 19.48+/-11.51, and 27.61+/-13.19 respectively. In motor nerve study, parameters for median nerve showed 9.35+/-1.64, 3.45+/-2.03, 47.95+/-9.91 respectively. And for ulnar nerve, they were 9.13+/-1.20, 2.95+/-2.50, and 43.70+/-7.24 respectively. In comparison with healthy elders, latency for Hansen patients was prolonged longer, lower amplitude, and also slower nerve conduction velocity. CONCLUSION: This study was performed for elderly Hansen patients for the first time demestically. Even the results may not be generalized for the whole Hansen patients because of the limited number of study cases and not being standarized according to the grade of disability, this study may be considered as a useful reference for further NCV for Hansen patients.
Aged ; Electrodes ; Fingers ; Hand ; Humans ; Leprosy* ; Male ; Median Nerve ; Neural Conduction* ; Peripheral Nervous System Diseases ; Ulnar Nerve ; Upper Extremity ; Wounds and Injuries

Ulnar nerve injury in closed fracture of forearm in children is uncommon.Commonly, neurapraxia is the reason for this palsy but other severe injuries or nerve entrapment has been reported in some cases. The importance of diagnosis concerning the types of the nerve injury lies in the fact that they have totally different management.We present a case of ulnar nerve deficit in a child following a closed fracture of the forearm bones. It is imperative to diagnose exact cause of palsy as it forms the basis for treatment. MRI scan can help diagnosis and accordingly guide the management. Simple nerve contusion should be treated conservatively, and exploration with fixation of the fracture should be done in lacerations and entrapments of the nerve. Surgery is not the treatment of choice in cases that could be managed conservatively.
Accidental Falls ; Child ; Diagnostic Errors ; Fractures, Closed ; complications ; diagnosis ; therapy ; Humans ; Magnetic Resonance Imaging ; Radius Fractures ; complications ; diagnosis ; therapy ; Ulna Fractures ; complications ; diagnosis ; therapy ; Ulnar Nerve ; injuries ; Ulnar Neuropathies ; diagnosis ; etiology