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Supracondylar Humeral Fractures with Isolated Anterior Interosseous Nerve Injuries: Is Urgent Treatment Necessary?

Barrett, Kody K. BA; Skaggs, David L. MD, MMM; Sawyer, Jeffrey R. MD; Andras, Lindsay MD; Moisan, Alice BSN, RN, CCRP; Goodbody, Christine BS; Flynn, John M. MD

Journal of Bone & Joint Surgery - American Volume: 5 November 2014 - Volume 96 - Issue 21 - p 1793–1797
doi: 10.2106/JBJS.N.00136
Scientific Articles
Disclosures

Background: It is unclear if pediatric patients with a supracondylar humeral fracture and isolated anterior interossous nerve injury require urgent treatment.

Methods: A retrospective, multicenter study of 4409 patients with operatively treated supracondylar humeral fractures was conducted. Exclusion criteria were additional nerve injuries other than the anterior interosseous nerve, any sensory changes, pulselessness, ipsilateral forearm fractures, open fractures, less than two months of follow-up, or pathological fractures.

Results: Thirty-five of 4409 patients met inclusion criteria. The average time to surgery was 14.6 hours (range, two to thirty-six hours). No patient developed compartment syndrome. There was no significant difference in time to return of anterior interosseous nerve function relative to the time to surgical reduction and fixation (p = 0.668). A complete return of anterior interosseous nerve function occurred in all patients with an average time of forty-nine days (range, two to 224 days). Ninety percent of patients recovered anterior interosseous nerve function by 149 days.

Conclusions: To our knowledge, this is the largest series to date of supracondylar humeral fractures with anterior interosseous nerve injuries. There is no evidence that a supracondylar humeral fracture with an isolated anterior interosseous nerve injury requires urgent treatment. A delay in treatment up to twenty-four hours was not associated with an increased time of nerve recovery or other complications. This series excluded patients with sensory nerve injuries, pulselessness, and ipsilateral forearm fractures, which all may require urgent surgery. Barring other clinical indications for urgent treatment of a supracondylar humeral fracture, an isolated anterior interosseous nerve injury (no sensory changes) may not by itself be an indication for urgent surgery. The anterior interosseous nerve injuries in this series showed complete recovery at a mean time of forty-nine days.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Boulevard, MS#69, Los Angeles, CA 90027. E-mail address for D.L. Skaggs: dskaggs@chla.usc.edu

2Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 520, Memphis, TN 38104

3Le Bonheur Children’s Hospital, 50 North Dunlap Street, Memphis, TN 38103

4Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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