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Neurovascular injuries in type III humeral supracondylar fractures in children
S T Lyons1, M Quinn, C L Stanitski
1Department of Orthopaedic Surgery, Children's Hospital of Michigan, Wayne State University, Detroit, USA.
Insights
Humeral supracondylar fractures in children often cause nerve and vascular injuries. Fracture displacement patterns can predict specific nerve damage, aiding early clinical assessment, especially for the anterior interosseous nerve.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Pediatric Surgery
Background:
- Supracondylar humerus fractures are common pediatric elbow injuries.
- Type III extension fractures carry a significant risk of neurovascular complications.
Purpose of the Study:
- To determine the incidence of neural and vascular injuries in Type III extension supracondylar humeral fractures.
- To identify the types of nerves most frequently injured.
- To correlate fracture displacement patterns with neurovascular compromise.
Main Methods:
- Retrospective review of clinical and radiographic records.
- Analysis of 210 consecutive pediatric patients treated for Type III extension supracondylar humeral fractures.
- Correlation of fracture displacement with documented neural and vascular injuries.
Main Results:
- 19.1% of patients experienced neural compromise, vascular compromise, or both.
- Nerve injuries occurred in 13.3%, combined injuries in 2.9%, and vascular injuries in 2.9%.
- Median nerve injuries (58.9%), particularly anterior interosseous nerve lesions (80%), were most common, followed by radial and ulnar nerve injuries.
- Posterolateral displacement correlated with median nerve and vascular compromise; posteromedial displacement correlated with radial nerve injury.
Conclusions:
- Fracture displacement patterns are valuable predictors of specific neurovascular injuries in pediatric supracondylar humeral fractures.
- Understanding these patterns aids targeted clinical examination, especially for difficult-to-assess injuries like anterior interosseous nerve lesions in uncooperative children.
Abstract:
Clinical and radiographic records of 210 consecutive children treated for Type III extension humeral supracondylar fractures during a 66-month period were reviewed retrospectively to determine (1) the incidence of neural and vascular injuries associated with this fracture; (2) the frequency of the type of nerve injured; and (3) the relationship of fracture displacement to neural and vascular compromise. Forty patients (19.1%) had neural compromise, vascular compromise, or both. Nerve injuries occurred in 13.3% of patients, combined nerve and vascular compromise occurred in 2.9%, and vascular compromise occurred in 2.9% of patients. Median nerve injuries accounted for 58.9% of nerve injuries followed by radial (26.4%) and ulnar (14.7%) lesions. Eighty percent of the median nerve injuries involved the anterior interosseous nerve. Posterolateral fracture displacement was correlated with median nerve and vascular compromise. Posteromedial fracture displacement strongly correlated with radial nerve injury. Recognition of fracture displacement pattern provides a guide to clinical examination to assess associated neural injury, in particular, the anterior interosseous nerve, which may be difficult to evaluate in a child who is uncooperative.
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