Prognosis and Risk Factors of Nerve Injuries in Displaced Pediatric Supracondylar Humerus Fractures

Abstract

Background: Supracondylar humerus (SCH) fractures are serious injuries due to the neighborhood of critical neural and vascular structures. One of  the most devastating complications of SCH fractures is neurological damage, since it may cause permanent disability. The aim of this study is to categorize neurological complications, to report long‑term functional outcomes, and to determine risk factors associated with childhood SCH fractures.

Methods: The records of 375 children were reviewed retrospectively. Data about amount and direction of displacement, the shape of the fracture,  age at the time of fracture, gender, time from impaction to surgery, time of surgery, type of neurological injury, and recovery time were recorded.

Results: Neurological complications were seen in 37 (9.85%) children. Thirteen (35.1%) of the children had an iatrogenic nerve injury. All iatrogenic injuries were fully recovered in this study. However, 2 children who had combined neurological injury of radial, ulnar, and median nerves did not recover. Nearly 95% of all children who had neurological injury recovered fully. An anterior long and sharp bone fragment (spike) was observed in  most of the children with neurological injury, and this spike was seen in 14 (58.3%) patients who had a trauma‑related injury (n = 24).

Conclusion: The prognosis of these nerve injuries is excellent, especially the iatrogenic ones. A long and sharp bone fragment (spike) may be  responsible for nerve injuries in some children. Surgical exploration is not necessary after an iatrogenic nerve injury when there is no neurotmesis.  Patience and care are utmost needed to handle neurological complications.

Keywords: Cross‑pinning, iatrogenic nerve injury, neurological injury, prognosis, supracondylar fracture