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Nerve injuries in supracondylar fractures of the humerus in children: Is nerve exploration indicated?

Khademolhosseini, Majid; Abd Rashid, Abdul Halim; Ibrahim, Sharaf

Journal of Pediatric Orthopaedics B: March 2013 - Volume 22 - Issue 2 - p 123–126
doi: 10.1097/BPB.0b013e32835b2e14
Upper Limb

A retrospective study of nerve injuries with displaced supracondylar fractures of the humerus in children younger than 12 years of age, treated in Hospital Universiti Kebangsaan Malaysia. Our objectives were to determine the incidence of primary and iatrogenic nerve injuries in supracondylar humerus fractures Gartland types II and III and to determine the outcome of nerve recovery. A total of 272 patients with displaced supracondylar humerus fractures who required admission to Hospital Universiti Kebangsaan Malaysia from January 2000 to December 2007 were reviewed. There were 182 boys (67%) and 90 girls (33%). The mean age was 6.0 years, ranging from 1 to 12 years. Of 272 supracondylar fractures, 79 were type II and 193 were type III. Fifty-one (19%) patients had closed reduction, 160 (59%) had closed reduction and percutaneous crossed Kirschner (K) wires, and 61 (22%) had open reduction and crossed K-wires. Associated nerve injuries involving the median, radial, and ulnar nerves were observed in 48 (18%) patients. Nerve injuries were observed in nine (3%) patients upon admission. Thirty-nine (14%) patients developed nerve injuries following treatment. Of these 39 patients, 34 had ulnar, three had radial, and two had median nerve injuries. Nerve exploration was performed in five patients (in four patients following debridement of open fracture and in one because of unacceptable postoperative radiographs, and they subsequently underwent open reduction and exploration). Except for these five patients, the K-wires were not removed earlier nor were the nerves surgically explored in others. The nerve injuries resolved clinically on an average time of 3.5 months (range from 3 weeks to 8 months). Our study found complete resolution of all patients with nerve injuries confirmed by clinical assessment. On the basis of our study, we believe that there is no indication to remove the K-wires immediately or to explore the nerve surgically following a mini-open technique, which reduces the risk of penetrating a nerve during pinning.

Department of Orthopaedics and Traumatology, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia

Correspondence to Abdul Halim Abd Rashid, MS Ortho, Department of Orthopaedics and Traumatology, Faculty of Medicine, National University of Malaysia, Jalan Yaacob Latif, 56000 Cheras, Kuala Lumpur, Malaysia Tel: +60 193 688 153; fax: +60 391 738 609; e-mail: drhalimrashid@yahoo.com

© 2013 Lippincott Williams & Wilkins, Inc.