Delayed Radial Nerve Laceration by the Sharp Blade of a Medially Inserted Kirschner-Wire Pin: A Rare Complication of Supracondylar Humerus Fracture

Abstract not available. Introduction provided instead.

Supracondylar humerus fracture is one of the most common fractures in children and the most common pediatric elbow fracture. It usually occurs during a fall onto an outstretched hand¹ and is associated with considerable morbidity, including neurovascular complications, malunion, myositis ossificans, and compartment syndrome.^1-3 The most common complication is nerve damage, which in some cases causes paralysis. Primary nerve injuries occur in up to 20% of displaced supracondylar fractures.^2,4 Secondary nerve injuries are usually caused by stretching, laceration, or entrapment of the nerve between the ends of the fracture.²

In most cases of supracondylar humerus fractures, the treatment of choice is closed reduction and percutaneous pinning.^5-7 After 3 to 4 weeks of immobilization, the pins should be removed. During Kirschner-wire (K-wire) pin placement, there is a risk for nerve damage, particularly ulnar nerve damage during insertion of a medial pin.^5-9

The literature includes many reports of ulnar nerve damage during medial pinning, but radial nerve laceration by a medially inserted pin that crosses the anterolateral cortex of the humerus is rare. In this article, we report the case of a patient who, 8 years after being treated for a supracondylar humerus fracture, presented with radial nerve palsy caused by repeated trauma from the sharp blade of a medially inserted K-wire pin.