Abstract
Aim: To determine the incidence, percentage, possibilities of examination and treatment of peripheral nerve injuries in supracondylar humerus fractures in children. Methods: A retrospective study of patients with peripheral nerve injury in supracondylar fractures treated at the Department of Paediatric Surgery and Traumatology, University Hospital Hradec Králové in 2008-2015.
Results: During this period, among the total of 786 patients with supracondylar humerus fractures requiring surgical treatment, concurrent peripheral nerve injury was identified in 59 patients, most frequently n. medianus (57.6%) and n. ulnaris (23.7%). The overall incidence of the isolated n. ulnaris injury (4.6%) corresponded with the published data.
Acute treatment of peripheral nerve injury was mostly conservative, more than 37% of nerve lesions recovered within 1 month from the accident, after 6 months the percentage of recovered cases was almost 80%. In two cases (3.4 %), it was necessary to perform microsurgical deliberation of the fixed nerve from the fracture callus 4 months after the injury.
Three patients had minor permanent paresthesias. Conclusion: Peripheral nerve injuries are a common complication of supracondylar humerus fractures in children.
The majority of injuries were neuropraxia or axonotmesis receding after adequate conservative treatment. No immediate operative revision or suture was performed in any patient.
Surgical deliberation of the peripheral nerve was performed in two cases 4 months after the primary injury. We did not notice a higher incidence of the ulnar nerve injury in the cross-pinning type of osteosynthesis compared to commonly published data on other methods of fixation.
None of the patients have permanent consequences affecting their everyday life.