![]() Cross pinning for supracondylar humerus fractures in children carries risk of iatrogenic ulnar nerve injuries 2 years after the pinning, one of the 17 children with ulnar nerve injury had persistent motor weakness and a sensory deficit medial pin was associated w/ ulnar n injury in 4% patients in whom the pin was applied w/o hyperflexion of the elbowĪnd in 15% in whom the medial pin was applied w/ elbow hyperflexed ulnar nerve injury was not seen in the 125 patients in whom only lateral pins were used configuration of the pins did not affect the maintenance of reduction of either type-2 fractures or type-3 fractures consider placing a temporary 2nd pin thru the lateral condyle to achieve even more stability insert lateral pin first to obtain stability while reduction is evaluated (avoids need to repeatedly insert medial pins if reduction is ![]() pin should avoid the olecranon fossa and should come to rest along the far cortex generally, the pin is aimed 35 deg upward and 10 deg posterior wire is inserted thru the capitellum, and then the distal humeral physis because the center of the capitellum is in line w/ anterior aspect of humeral shaft, the pin must be directed slightly posteriorly insertion point is in the center of lateral condyle (capitellum) Safe Zone for Superolateral Entry Pin Into the Distal Humerus in Children: An MRI Analysis avoid directing pins too far anterior or posterior w/ children younger than 5-6 years, use 0.062 smooth K wire pins need to be smooth w/ trochar point w/ posterolateral displacement, place arm in maximum internal rotaiton on the flourscopy platform, and insert the lateral pin first w/ posteromedial displacement, place arm in maximum external rotation on flourscopy platform, and insert the medial pin first pins should cross proximal to the frx at an angle of about 30 deg to the humeral shaft consider applying sterile "coband" to keep elbow flexed, which then allows arm to be externally rotated to achieve a lateral in preparing for crossed pinning, keep elbow hyperflexed to maintain reduction 2 lateral pins may not permit full elbow extension, thus preventing full assessment of carrying angle medial and lateral pin insertion provides better stabilization either two lateral pins, or one lateral and one medial pin may be used and both should penetrate the cortex The fentanyl consumption was higher intraoperatively and rescue analgesic doses were more in group I.Ĭonclusion: USG guided brachial plexus block is an excellent and effective means for analgesia in CRPP for supracondylar fracture with lower intraoperative Opioid consumption and better postoperative analgesia, lower pain scores and Opioid consumption in first 24 hour post operative period.- has become standard technique for stabilizing types II & type III frx Duration of analgesia was significantly higher (746.6±40.2 min) and mean pain scores lower in first 24 hour. The incidence of PONV was 24% (group I) and 16% (GroupII). Time to first dose of analgesia after surgery in the group I was 54.8±5.4 min and 746.6±40.2 min (p<0.001). Results: Demographic data were similar in both groups (I and II). Methods: A total of 50 paediatric patients were included who were to undergo CRPP and divided into two groups Group I- General anaesthesia alone (n = 25), Group II- General anaesthesia with USG guided supraclavicular brachial plexus block studied for the intraoperative opioid consumption as well as postoperative analgesia quality, duration and Opioid consumption. Regional anesthesia may represent one of the best solutions for intraoperative and postoperative paediatric pain management however, due to lack of proficiency and the increased risk of complications in children and difficulty in obtaining cooperation compared to adults, it is not the method of choice for most of the anesthesiologists in children. Background: Supracondylar fracture of the humerus is one of the commonly encountered injuries in paediatric age group accounting for 16% of all paediatric fractures and 60% of all paediatric elbow fractures, classically occurring as a result of fall on an outstretched hand.
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