Management of Supracondylar Fractures in the Prone Position: Case Series, Technique, and Literature Review

In displaced supracondylar humerus fractures, closed reduction percutaneous pinning is recommended and is most commonly performed in the supine position with the arm held in hyperflexion. The risk of iatrogenic ulnar nerve injury with medial pin placement is high in this position. We performed a retrospective case series of 149 patients with displaced supracondylar humerus fractures treated in the prone position. The aim of this study was to evaluate the incidence of iatrogenic ulnar nerve injury with medial pin placement, report our technique, and conduct a literature review to serve as historical control. The rate of iatrogenic ulnar nerve injury was evaluated and compared with a historical control cohort of 1029 patients treated supine. A total of 131 patients were included: 74 (56%) patients received a medial pin, and 57 (44%) patients received lateral pins only. Postoperative complications included 2 cases of pin migration (1.5%). No patients sustained iatrogenic ulnar nerve injury, compared with a historical control rate of 4.95%. Our technique is correlated with a lower incidence of ulnar nerve injuries than historical controls performed in the supine position. We believe this technique can facilitate safer pin placement in cases that require a medial pin. Level of Evidence: Level IV.