{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:28:56Z","timestamp":1790688536472,"version":"4.1.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric Gartland type III\u2013IV extension-type supracondylar humeral fractures are associated with a risk of iatrogenic ulnar nerve injury during medial percutaneous pin insertion. The optimal technique for medial pin placement during crossed pin fixation remains debated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective case-control study was conducted involving 80 pediatric patients treated between September 2020 and September 2025. All patients had isolated closed extension-type Gartland III\u2013IV supracondylar humeral fractures treated with two lateral and one medial crossed K-wires, with a minimum follow-up of 6 months. Patients were divided into the K-Hammer group, in which medial pinning was performed using a non-rotational K-Hammer-assisted technique with the elbow in 30\u00b0\u201360\u00b0 extension, and the Freehand group, in which medial pinning was performed using conventional low-speed drilling with the elbow flexed at 90\u00b0. The primary outcome was symptomatic iatrogenic ulnar nerve injury within 2 weeks postoperatively. Secondary outcomes included medial pin attempts, operative time, radiographic alignment, elbow range of motion, Flynn functional grade, and postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The K-Hammer group had significantly fewer medial pin attempts [1.0 (IQR: 1.0\u20131.0) vs. 2.0 (IQR: 1.0\u20132.0),\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001] and shorter operative time (32.8\u2009\u00b1\u20096.9 vs. 37.9\u2009\u00b1\u20099.2\u2005min,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.006). Intraoperative pink pulseless hand rates were comparable (10.5% vs. 4.8%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.416), and all patients recovered radial pulse postoperatively. Iatrogenic ulnar nerve injury occurred in 0% (0\/38) of the K-Hammer group vs. 11.9% (5\/42) of the Freehand group (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.056), corresponding to an exploratory absolute risk reduction (ARR) of 11.9% and a number needed to treat (NNT) of approximately 8.4. No secondary displacement or reoperation occurred in either group. Pinsite infection and myositis ossificans rates were low and similar. At a median follow-up of 7.5 months (IQR: 6.2\u201311.8; range: 6\u201336 months), radiographic and functional were comparable between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The K-Hammer technique improves operative efficiency, reduces pin insertion attempts, and demonstrates a favorable trend toward reduction in iatrogenic ulnar nerve injury risk (ARR 11.9%, NNT\u2009=\u20098.4), without compromising radiographic or functional outcomes. Although statistical significance was not reached (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.056), likely due to limited sample size, these findings suggest it is a potential technical option for medial pin placement in severe pediatric supracondylar humeral fractures, warranting confirmation in larger prospective studies.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1873170","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:35:15Z","timestamp":1783575315000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Non-rotational medial pinning with the K-Hammer technique in pediatric supracondylar fractures: a retrospective case-control study"],"prefix":"10.3389","volume":"14","author":[{"given":"Xiang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Hunan Provincial People\u2019s Hospital and The First Affiliated Hospital of Hunan Normal University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoan","family":"Bai","sequence":"additional","affiliation":[{"name":"Xiangya School of Medicine , Changde Hospital, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changhong","family":"Li","sequence":"additional","affiliation":[{"name":"Xiangya School of Medicine , Changde Hospital, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Xiangya School of Medicine , Changde Hospital, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Xiangya School of Medicine , Changde Hospital, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanwen","family":"Sun","sequence":"additional","affiliation":[{"name":"Xiangya School of Medicine , Changde Hospital, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Second Xiangya Hospital of Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijun","family":"Zhou","sequence":"additional","affiliation":[{"name":"Xiangya School of Medicine , Changde Hospital, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1302\/2058-5241.3.170049","article-title":"Management of supracondylar fractures of the humerus in children","volume":"3","author":"Vaquero-Picado","year":"2018","journal-title":"EFORT Open Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.2106\/JBJS.G.01354","article-title":"Supracondylar humeral fractures in children","volume":"90","author":"Omid","year":"2008","journal-title":"J Bone Joint Surg Am"},{"key":"B3","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1097\/BPO.0b013e3181d213a6","article-title":"Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis","volume":"30","author":"Babal","year":"2010","journal-title":"J Pediatr Orthop"},{"key":"B4","doi-asserted-by":"publisher","first-page":"706","DOI":"10.2106\/JBJS.F.00379","article-title":"Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children: a randomized clinical trial","volume":"89","author":"Kocher","year":"2007","journal-title":"J Bone Joint Surg Am"},{"key":"B5","first-page":"421","article-title":"Supracondylar humerus fractures: when lateral entry pins are not enough","volume":"73","author":"Fabricant","year":"2024","journal-title":"Instr Course Lect"},{"key":"B6","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1097\/bpo.0b013e3180316cf1","article-title":"A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus","volume":"27","author":"Brauer","year":"2007","journal-title":"J Pediatr Orthop"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e70404","DOI":"10.7759\/cureus.70404","article-title":"A comparison of nerve injury in cross versus lateral pinning fixation of displaced supracondylar humerus fracture","volume":"16","author":"Mannan","year":"2024","journal-title":"Cureus"},{"key":"B8","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1302\/0301-620X.108B2.BJJ-2024-1529.R2","article-title":"Management of displaced supracondylar fractures of the humerus using lateral versus crossed Kirschner wires: a prospective randomized controlled clinical trial","author":"Dobbe","year":"2026","journal-title":"Bone Joint J"},{"key":"B9","doi-asserted-by":"publisher","first-page":"111201","DOI":"10.1016\/j.ejrad.2023.111201","article-title":"The use of ultrasound for monitoring reduction and ulnar nerve subluxation in pediatric humeral supracondylar fractures","volume":"170","author":"Shih","year":"2024","journal-title":"Eur J Radiol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1097\/01241398-200207000-00006","article-title":"Predicting ulnar nerve location in pinning of supracondylar humerus fractures","volume":"22","author":"Wind","year":"2002","journal-title":"J Pediatr Orthop"},{"key":"B11","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1302\/0301-620X.90B5.19820","article-title":"The assessment of the ulnar nerve at the elbow by ultrasonography in children","volume":"90","author":"Shen","year":"2008","journal-title":"J Bone Joint Surg Br"},{"key":"B12","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1097\/01241398-199609000-00003","article-title":"Ulnar nerve instability in children","volume":"16","author":"Zaltz","year":"1996","journal-title":"J Pediatr Orthop"},{"key":"B13","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1097\/BPB.0b013e328010b684","article-title":"Prevention of ulnar nerve injury during fixation of supracondylar fractures in children by \u2018flexion-extension cross-pinning\u2019 technique","volume":"16","author":"Eidelman","year":"2007","journal-title":"J Pediatr Orthop B"},{"key":"B14","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1186\/s12891-025-09001-3","article-title":"Ultrasound-guided cross-pin technique for paediatric supracondylar humerus fractures: minimizing iatrogenic ulnar nerve injury","volume":"26","author":"Wu","year":"2025","journal-title":"BMC Musculoskelet Disord"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1718195","DOI":"10.3389\/fped.2025.1718195","article-title":"K-Hammer percutaneous fixation: a novel technique for preventing iatrogenic ulnar nerve injury in pediatric supracondylar humeral fractures","volume":"13","author":"Zhou","year":"2025","journal-title":"Front Pediatr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1302\/0301-620X.88B1.16869","article-title":"Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children: the experience of a specialist referral centre","volume":"88","author":"Ramachandran","year":"2006","journal-title":"J Bone Joint Surg Br"},{"key":"B17","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1302\/0301-620X.98B6.35686","article-title":"Nerve injuries associated with supracondylar fractures of the humerus in children: our experience in a specialist peripheral nerve injury unit","author":"Kwok","year":"2016","journal-title":"Bone Joint J"},{"key":"B18","doi-asserted-by":"publisher","first-page":"3771","DOI":"10.1007\/s00381-024-06497-3","article-title":"Peripheral nerve injuries associated with dislocated supracondylar fractures of distal humerus in children: incidence and need of surgical treatment","volume":"40","author":"Chrenko","year":"2024","journal-title":"Childs Nerv Syst"},{"key":"B19","doi-asserted-by":"publisher","first-page":"4487507","DOI":"10.1155\/cro\/4487507","article-title":"Iatrogenic ulnar nerve injury post\u2013K-wire fixation of supracondylar humeral fracture in a child with ulnar nerve instability: a case report and review of the literature","volume":"2026","author":"Mostafa","year":"2026","journal-title":"Case Rep Orthop"},{"key":"B20","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1177\/18632521221124632","article-title":"Management of iatrogenic ulnar nerve palsies after cross pinning of pediatric supracondylar humerus fractures: a systematic review","volume":"16","author":"Graff","year":"2022","journal-title":"J Child Orthop"},{"key":"B21","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/s12306-013-0291-y","article-title":"Ulnar nerve morbidity as a long-term complication of pediatric supracondylar humeral fracture","volume":"98","author":"Sinikumpu","year":"2014","journal-title":"Musculoskelet Surg"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1873170\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T05:35:16Z","timestamp":1783575316000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1873170\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":21,"alternative-id":["10.3389\/fped.2026.1873170"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1873170","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"article-number":"1873170"}}