The Journal of Bone and Joint Surgery, Vol 72, Issue 8 1211-1215, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Neural injuries associated with supracondylar fractures of the humerus in children
RW Culp, AL Osterman, RS Davidson, T Skirven and FW Bora
Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Pennsylvania 19104.
A retrospective review of displaced extension-type supracondylar fractures
of the humerus in 101 children who were seen consecutively revealed
eighteen associated neural injuries in thirteen children. Nine of the
neural injuries in eight patients spontaneously resolved at a mean of 2.5
months (range, 1.5 to five months) after injury. The remaining nine lesions
in five patients were explored at a mean of 7.5 months (range, five to
fourteen months) after injury, because clinical and electromyographic
studies showed no return of function. Neurolysis was performed on eight of
the nerves that were explored (in five patients), and the remaining radial
nerve was found to be completely lacerated and needed nerve-grafting. The
length of follow-up after neurolysis averaged twenty-five months (range,
thirteen to forty-four months). All five patients had functional recovery,
as documented by range-of-motion, grip-strength and lateral pinch-strength,
and von Frey and two-point-discrimination sensory testing. The patient who
had had nerve-grafting never recovered neural function, and tendon
transfers were needed. We concluded that observation and supportive therapy
is the preferred initial approach for children who have a neural injury
associated with a closed, displaced supracondylar fracture of the humerus.
However, if there is no clinical or electromyographic evidence of return of
neural function at five months after injury, exploration and neurolysis
should be performed. If the nerve is in continuity, the prognosis after
neurolysis is excellent.
CiteULike 
Connotea 
Del.icio.us 
Technorati What's this?
