Risk of ulnar nerve injury during cross-pinning in supine and prone position for supracondylar humeral fractures in children: a recent literature review

Aim of this review article is to evaluate the percentage of ulnar nerve lesion during cross-pinning considering the patient's position (supine or prone) on the surgical bed. Comprehensive research was performed by searching in PUBMED, Cochrane Library, ISI Web of Science, SCOPUS and Clinicaltrials.gov from 2005. Children with extension type supracondylar humeral fractures without clinical signs of ulnar nerve lesion at presentation were included. A total of 28 papers were examined including 2147 patients; 1541 underwent a closed reduction and cross-pinning in supine position and 606 in prone position. Among 1541 patients in supine position, 69 (4.5%) suffered from a ulnar nerve injury while among the 606 patients treated in prone position none ulnar nerve lesions were reported. Despite the apparent safety of prone position, further larger studies, comparing the patient's position on the surgical bed, need to be carried out in order to confirm this likelihood.