Iatrogenic Ulnar Nerve Injury Post–K‐Wire Fixation of Supracondylar Humeral Fracture in a Child With Ulnar Nerve Instability: A Case Report and Review of the Literature

Background Iatrogenic ulnar nerve damage is not an uncommon consequence after K‐wire fixation of supracondylar humeral fractures in children. The risk of injury may be increased when the ulnar nerve is hypermobile. Case Report We present a 7‐year‐old boy who underwent closed reduction and crossed K‐wire fixation for a Gartland Type IIb supracondylar fracture of the right humerus. The ulnar nerve was not palpable in the cubital tunnel but felt as a cord‐like structure in front of the medial epicondyle. Immediately following surgery, the patient developed paresthesia and painful incomplete clawing of the ring and little fingers. Exploration on the second day of surgery revealed the ulnar nerve anterior to the medial epicondyle and tented over the K‐wire. The K‐wire was replaced with one more lateral pin, and the nerve was decompressed. Complete recovery of nerve injury was noticed 4weeks after exploration. Conclusion Given the greater prevalence of ulnar nerve instability among children, it is prudent to preoperatively evaluate patients for evidence of ligament laxity or ulnar nerve instability of the contralateral normal elbow. Prompt exploration and K‐wire removal can confirm nerve continuity, reassure the family, and ensure swift recovery from nerve injury.