Excellent long-term function seen in pediatric patients with supracondylar fracture, nerve injury

Investigators of this study found excellent functional outcomes at an average 8.6-years follow-up among most pediatric patients with a supracondylar humeral fracture and a neurological injury who were surgically treated, and discovered full recovery of most nerve injuries. However, they noted 25% of ulnar nerves injuries fully recovered.

Researchers retrospectively reviewed the medical records of 448 children with supracondylar humeral fractures. Patients were asked to perform a grip and pinch test, and a sensibility test. Functional outcomes were assessed with the QuickDASH, Flynn score and Mayo Elbow Performance score. Data recorded included age at time of fracture, gender, injury side, surgery type, neurological injury type and recovery time. Average follow-up was 8.6 years.

Of the 448 children, 29 children had supracondylar humeral fractures with neurological injuries. Medical records showed the median nerve was injured in 13 patients, 14 patients had a radial nerve injury and nine patients had an ulnar nerve injury. Patients had a mean age of 7.5 years at the time of fracture and had a mean age of 16 years at the time of revision.

Flexion decreased in the injured elbow vs. the contralateral elbow; however, differences were not statistically significant with regard to extension, pronation and carrying angle. The injured side vs. the non-injured side had significantly less grip and pinch strength.

Seven patients noted paresthesias. Of these, six patients at the latest follow-up noted paresthesias in the ulnar nerve territory. Overall, patients had an average QuickDASH score of 4±3. Investigators found an average Mayo Elbow Performance Score of 96±7, and 10 cases were deemed as satisfactory using the Flynn score.

At the final follow-up, two patients had complete recovery of their ulnar nerve injury; six patients had full recovery of their radial nerve injury and six patients had complete recovery of their median nerve injury.

“Functional results were excellent in the majority of patients. Almost half of the patients referred paresthesias, mostly in the ulnar nerve territory, that were not limiting normal daily activity,” the authors wrote. “At final follow-up, although 100% of the radial nerve injuries and 87.5% of the median nerve injuries were fully recovered, only 25% of the ulnar nerve injuries were.”‒ by Monica Jaramillo

Disclosures: The researchers report no relevant financial disclosures.

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Source:

Valencia M, et al. J Pediatr Orthop. 2015;doi:10.1097/BPO.0000000000000337.