Paediatric supracondylar fractures are the most common elbow fracture in children, and is associated with an 11% incidence of neurologic injury. The goal of this study is to investigate the natural history and outcome of motor nerve recovery following closed reduction and percutaneous pinning of this injury. A total of 246 children who underwent closed reduction and percutaneous pinning following supracondylar humerus fractures were prospectively enrolled over a two year period. Patient demographics (age, weight), Gartland fracture classification, and associated traumatic neurologic injury were collected and analyzed with descriptive statistics. Patients with neurologic palsies were separated based on nerve injury distribution, and followed long term to monitor for neurologic recovery at set time points for follow up. Of the 246 patient cohort, 46 patients (18.6%) sustained a motor nerve palsy (Group 1) and 200 patients (82.4%) did not (Group 2) following elbow injury. Forty three cases involved one nerve palsy, and three cases involved two nerve palsies. No differences were found between patient age (Group 1 – 6.6 years old, Group 2 – 6.2 years old, p = 0.11) or weight (Group 1 – 24.3kg, Group 2 – 24.5kg, p = 0.44). A significantly higher proportion of Gartland type III and IV injuries were found in those with nerve palsies (Group 1 – 93.5%, Group 2 – 59%, p < 0 .001). Thirty four Anterior Interosseous Nerve (AIN) palsies were observed, of which 22 (64.7%) made a full recovery by three month. Refractory AIN injuries requiring longer than three month recovered on average 6.8 months post injury. Ten Posterior Interosseous Nerve (PIN) palsies occurred, of which four (40%) made full recovery at three month. Refractory PIN injuries requiring longer than three month recovered on average 8.4 months post injury. Six ulnar nerve motor palsies occurred, of which zero (0%) made full recovery at three month. Ulnar nerve injuries recovered on average 5.8 months post injury. Neurologic injury occurs significantly higher in Gartland type III and IV paediatric supracondylar fractures. AIN palsies remain the most common, with an expected 65% chance of full recovery by three month. 40% of all PIN palsies are expected to fully recover by three month. Ulnar motor nerve palsies were slowest to recover at 0% by the three month mark, and had an average recovery time of approximately 5.8 months. Our study findings provide further evidence for setting clinical and parental expectations following neurologic injury in paediatric supracondylar elbow fractures

Introduction. Both cross and lateral pinning are common techniques used for displaced supracondylar elbow fractures in children. Our study aims to determine whether there are any radiological differences in outcome between the two techniques. Most recent studies involving radiological evaluation of supracondylar fractures had concentrated on use of Bauman's angle or humerocapitellar angles. Rotational displacement, which has been shown to be critical for stability, is often not adequately addressed. Our evaluation measures both linear displacement using Bauman's angle and rotational displacement through the measurement of the lateral rotational percentage (LRP). Method. We retrospectively reviewed the radiographs of all type III supracondylar fractures reduced with either crossed pins (one medial and one lateral, one medial and two lateral) or lateral pins (two or three lateral) between 2002 and 2006 at the Royal Children's Hospital. A good quality AP and lateral radiograph taken preoperatively, immediately postoperatively, and at the first follow up session was required for patients to be included in the study. Those that had LRP change of greater than 10% were further investigated. Results. 66 of the 184 patients identified with type III supracondylar fracture with k wire fixation had adequate radiographs for the study. Thirty-three in the lateral pinning group and 33 in the cross pinning group. Results using Mann-Whitely test show nil significant differenced between the crossed and lateral pinned groups in terms of both Bauman's (p value 0.5767) angle and Lateral Rotational Profile (p value 0.063). Those that had LRP change were further investigated. The results showed that there was no difference between the cross pinning and lateral pinning in carrying angle or range of motion by the time of their last follow up. Conclusion. There is no significant difference in terms of the rate of loss of reduction radiologically using either the lateral pinning or crossed pinning method for treatment of type III supracondylar fractures in children

Aims

The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service.