Neurologic Deficits: following Supracondylar Frx

- See: Nerve Injury

- Discussion: 
     - always consider an occult compartment syndrome before a neurpraxia;
     - median nerve:
            - most common neural injury is to anterior-interosseous branch;
                   - in type III frx, upto 50% of pts may show median nerve deficits;
                   - is frequently missed because of lack of sensory changes;
            - may be seen injured in postero-laterally displaced supracondylar frx & is associated w/ vascular injuries;
            - nerve is tethered on the medial spike of proximal fragment;
            - note that a median nerve palsy may mask a pending compartment syndrome;
            - references:
                   - Incidence of anterior interosseous nerve palsy in supracondylar humerus fractures in children.
                   - Supracondylar humeral fractures with isolated anterior interosseous nerve injuries: is urgent treatment necessary?
                   - The irreducible supracondylar fracture of the humerus complicated by anterior interosseous nerve palsy
                   - Iatrogenic nerve injuries in the treatment of supracondylar humerus fractures: are we really just missing nerve injuries on preoperative examination?

     - radial nerve;
            - may be injured by anterior spike of proximal fragment of humerus w/ supracondylar frx w/ post-medial displacement;
            - in type III frx, upto 25% of pts may show radial nerve deficits; 
            - ref: Iatrogenic nerve injuries in supracondylar humerus frx: are we really just missing nerve injuries on preop exam?

     - ulnar nerve:

            - Tardy ulnar nerve palsy in cubitus varus deformity associated with ulnar nerve dislocation in adults.
            - Analysis of tardy ulnar nerve palsy associated with cubitus varus deformity after a supracondylar fracture of the humerus: a report of four cases.
            - Tardy ulnar nerve palsy caused by cubitus varus deformity.
            - How should one treat iatrogenic ulnar injury after closed reduction and percutaneous pinning of paediatric supracondylar humeral fractures?
            - Ulnar nerve lesions after osteosynthesis of a supercondylar humerus fracture during childhood. Indications for revision

- Treatment:
    - most nerve palsies resulting from supracondylar frx are neuropraxias, and therefore will resolve spontaneously;
           - motor function should recover by 3 months and sensory changes should recover by 6 months;
    - a mixed palsy (motor loss but no sensory loss) may have a better prognosis than a complete palsy (motor and sensory loss)
    - ref: Nerve injuries in supracondylar fractures of the humerus in children: is nerve exploration indicated?

Nerve injuries associated with supracondylar fractures of the humerus in children: our experience in a specialist peripheral nerve injury unit.

Neural injuries associated with supracondylar fractures of the humerus in children.

Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children.

Acute Neurovascular Complications With Supracondylar Humerus Fractures in Children.

Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children: the experience of a specialist referral centre.

Neurovascular injuries in type III humeral supracondylar fractures in children.

Nerve Injuries Associated With Pediatric Supracondylar Humeral Fractures: A Meta-analysis

Long-term Functional Results of Neurological Complications of Pediatric Humeral Supracondylar Fractures

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, October 19, 2016 5:40 am