Advertisement for orthosearch.org.uk
Orthopaedic Proceedings Logo

Receive monthly Table of Contents alerts from Orthopaedic Proceedings

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Visit Orthopaedic Proceedings at:

Loading...

Loading...

Full Access

OUTCOME OF NERVE INJURY ASSOCIATED WITH SUPRACONDYLAR HUMERAL FRACTURES: THE EXPERIENCE OF A TERTIARY REFERRAL CENTRE



Abstract

Introduction: Traumatic and iatropathic nerve injuries complicate 6–16% of paediatric supracondylar extension fractures of the humerus. The majority recover spontaneously. This retrospective review of lesions referred to our tertiary unit determined the incidence of surgical intervention.

Methods: Between 1997–2002, 37 neuropathies (32 fractures) in 19 males and 13 females (mean age 7.9yrs) were referred for further management. 8 fractures were Gartland grade 2 and 24 grade 3. All fractures were closed. Two were originally treated non-operatively, 20 by closed reduction and percutaneous pinning and 10 by open reduction and internal fixation.

Results: The ulnar nerve was most frequently injured (19, 51.4%), followed by median (10, 27%) and radial (8, 21.6%) nerve palsies. 14 (37.8%) neuropathies were fracture-related but 23 (62.2%) were treatment-related. 10 patients (31.3%) required operative exploration. Three (9.4%) were listed for surgery but cancelled due to nerve recovery. Nerve grafting using either the forearm medial cutaneous nerve or the superficial radial nerve was necessary in 4 of 10 operated cases. 26 patients (81.3%) had excellent outcomes, 5 (15.6%) good and 1 (3.1%) fair.

Discussion: In contrast to current literature suggesting that 86 to 100% of supracondylar associated neuropathies recover spontaneously within 2 to 3 months, surgical exploration was required in over 30% of cases.

Correspondence should be addressed to BSCOS, c/o Royal College of Surgeons, 35 – 43 Lincoln’s Inn Fields, London, WC2A 3PN