Nerve injuries associated with supracondylar fractures of the humerus in children: our experience in a specialist peripheral nerve injury unit.
2016
Aims We aimed to identify the pattern of nerve injury associated with
paediatric supracondylar fractures of the humerus. Patients and Methods Over a 17 year period, between 1996 and 2012, 166 children were
referred to our specialist peripheral nerve injury unit. From examination
of the medical records and radiographs were recorded the nature
of the fracture, associated vascular and neurological injury, treatment
provided and clinical course. Results Of the 166 patients (111 male, 55 female; mean age at time of
injury was seven years (standard deviation 2.2)), 26 (15.7%) had
neurological dysfunction in two or more nerves. The injury pattern
in the 196 affected nerves showed that the most commonly affected
nerve was the ulnar nerve (43.4%), followed by the median (36.7%)
and radial (19.9%) nerves. A non-degenerative injury was seen in
27.5%, whilst 67.9% were degenerative in nature. Surgical exploration
of the nerves was undertaken in 94 (56.6%) children. The mean follow-up
time was 12.8 months and 156 (94%) patients had an excellent or
good clinical outcome according to the grading of Birch, Bonney
and Parry. Conclusion Following paediatric supracondylar fractures we recommend prompt
referral to a specialist unit in the presence of complete nerve
palsy, a positive Tinel’s sign, neuropathic pain or vascular compromise,
for consideration of nerve exploration. Take home message: When managed appropriately, nerve recovery
and clinical outcomes for this paediatric population are extremely
favourable. Cite this article: Bone Joint J 2016;98-B:851–6.
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