A Modified Technique for Medial Pin Placement in Pediatric Supracondylar Humerus Fractures

Background: Displaced pediatric supracondylar humerus fractures (PSHFs) commonly require surgical treatment. Medial pin placement can cause iatrogenic ulnar nerve injury. This study presents a modified, step-by-step cross-pinning technique for PSHFs designed to avoid iatrogenic ulnar nerve injury. Methods: We retrospectively included patients with PSHF (Gartland types III or IV) who underwent closed reduction and percutaneous cross-pinning at our hospital from June 2014 to December 2024. Demographic data, fracture type, and preoperative and postoperative neurological deficits were recorded. Results: A total of 40 patients (16 boys and 24 girls) with a mean age of 6.6 ± 2.2 years (range, 2–14) were included. Most injuries were type III (35/40; 87.5%), whereas five patients (12.5%) had type IV injuries. Our technique resulted in no new cases of postoperative ulnar neuropathy. Conclusions: This study describes a modified medial pin insertion technique for unstable PSHFs. Careful attention to medial pin placement can minimize iatrogenic ulnar nerve injury.