Ulnar nerve damage due to displaced Kirschner wire

Case contributed by Dr Akos Jaray

Presentation

Surgical fixation of a supracondylar fracture by K-wires. Weakening grip and ulnar side numbness of the right hand 3 weeks after fixation.

Patient Data

Age: 7 years
Gender: Female

Supracondylar elbow fracture fixed by Kirschner wires from ulnar and radial side.

Prominent medial displacement of the K-wire 3 weeks later.

Normal bony callus formation.

Following the ulnar nerve in transverse plane at the level of the distal humerus.

Note the pointed tip of the K-wire penetrating the ulnar nerve.
The normal fascicular pattern (transverse section) of the ulnar nerve is preserved proximal and distal to the point of injury.

Intraoperative photo confirms the presence of the K-wire penetrating the ulnar nerve.

Case Discussion

Rare complication of supracondylar fracture fixation. The displacement of the radial Kirschner wire resulted in severe nerve damage.

Neurosonographic findings are in complete agreement with the findings at surgery.

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