The crossed-pin construct in treatment of supracondylar fracture humerus
The three crossed-pin construct is done by 2 lateral pins and one medial pin.
Advantage
The three crossed-pin construct
was most stable in the fracture followed by the two crossed and three lateral
pins, and two lateral divergent pins demonstrated the
least torsional stability.
Disadvantage
The medial K wire may be complicated by ulnar nerve injury.
How to avoid iatrogenic ulnar nerve injury during medial K wire placement?
In order to avoid the risk of ulnar nerve injury, some precautions are suggested.
1- making a small incision over the medial epicondyle to directly visualize the nerve. It is especially important in a swollen elbow.
2- medial pinning while the elbow is in
extension.
3- application of the nerve stimulator to a needle or medial pin to localize the ulnar nerve.