Neurologic deficits linked with poorer outcomes in children with supracondylar humeral fractures

SEATTLE — Pediatric patients with supracondylar humeral fractures treated operatively have poorer outcomes if nerve injuries with neurologic deficits are present compared with patients who do not have such injuries, according to data presented at the American Society for Surgery of the Hand Annual Meeting, here.

“For those patients with a nerve injury, despite a rate of 100% spontaneous resolution in our population, they were associated with poorer outcome scores with regards to their happiness, upper extremity function, sports and physical function as well as with the QuickDASH scoring system,” Justin J. Ernat, MD, said.

Ernat and colleagues conducted a study of functional outcome measures from 199 patients (average age, 6.7 years) with operative supracondylar humerus fracture for a 3-year period. Presence and type of any discernable neurologic deficit was noted while functional outcome was determined via PODCI and QuickDASH values.

Controlled for injury data including fracture classification and pattern, patient age, vascular abnormality and open fracture, a multiple regression analysis was used to determine the relationship between nerve injury and functional outcome.

Overall, 22 patients (11%) showed 25 nerve injuries with neurologic deficits at initial presentation. The injuries included 10 anterior interosseous nerve deficits, five posterior interosseous nerve deficits, four ulnar nerve deficits and three each of median and radial nerve deficits.

Ernat said patients with neurologic injury had significantly lower outcome measures for pain, function, mobility and satisfaction than patients without neurologic injury. At final follow-up, all nerve injuries had healed with no residual nerve deficits noted and no additional intervention needed.

“We did not identify any differences in [these outcome measures] between specific types of nerve injuries,” Ernat said. – by Christian Ingram

Reference:

Ernat JJ. Paper #1. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 10-12, 2015; Seattle.

Disclosure: Ernat reports no relevant financial disclosures.