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Our 7-year old granddaughter broke her arm just above the elbow. They had to do surgery to pull the bones apart and put them back together again. In the process, a nerve was damaged. Was this a fluke or is this a common problem?

It sounds like the type of injury your granddaughter had was a supracondylar fracture. These can be tricky to treat because of the difficulty manipulating the bones back into normal alignment. With the new fluoroscopic X-ray imaging, the procedure can be done without an incision. This is called closed reduction. Once the bones are in place, special wires called Kirschner (K-wires) are used to hold it in place until healing occurs. The surgery is usually done with the child in the supine position (on his or her back). But there are problems using this position. It's difficult to hold the bone in place while inserting the wire. The elbow must be fully flexed making it difficult to get the fluoroscope arm around it. The arm must be rotated externally (outward) to get the proper view. Even with two people working together, it's difficult to keep the fracture reduced. The location of the ulnar nerve so close to the edge of the bone puts it at risk for damage during this procedure. When there's swelling, it can be difficult to see or feel the nerve. It's very easy to poke the ulnar nerve with the wire and cause nerve damage. In fact this type of complication occurs in up to six per cent of all cases.

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