Intraoperative Electrical Stimulation Can Identify Potential Ulnar Nerve Injury from Crossed Pinning of a Supracondylar Humerus Fracture.

Treatment of Gartland type III supracondylar fractures using reduction and crossed Kirschner wire fixation is considered the most stable method; however, there is a risk of iatrogenic ulnar nerve injury during medial pin placement. We describe a technique for intraoperative detection of such nerve injury.An inexpensive disposable nerve stimulator is set at 2 mA and applied directly to the Kirschner wires after placement, alerting the surgeon intraoperatively if a wire contacts the ulnar nerve. A positive response involves any finger motion with Kirschner wire stimulation. We recommend this novel method of intraoperative Kirschner wire stimulation using an inexpensive disposable nerve stimulator for simple, quick, safe, effective, and cost-efficient prevention of nerve injury during surgeries for supracondylar humerus fractures. Key Concepts: (1)Cross pinning with lateral and medial Kirschner wires provides optimal stability for treating type III supracondylar humerus fractures but there is a risk of ulnar nerve injury.(2)A novel technique using intraoperative electrical stimulation of Kirschner wires allows surgeons to safely identify nerve contact and prevent iatrogenic ulnar nerve injury.(3)This method uses a cost-effective disposable nerve stimulator and can be easily incorporated into standard surgical procedures without using excessive time or resources. Level of Evidence: IV.