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Management of Traumatic Nerve Palsies in Paediatric Supracondylar Humerus Fractures: A Systematic Review
Christy Graff1,2,3, George Dennis Dounas1,2,3, Maya Rani Louise Chandra Todd2,3
1The Women's and Children's Hospital, North Adelaide, SA 5006, Australia.
Insights
Most pediatric supracondylar humerus fractures with nerve injuries heal spontaneously. Nerve exploration surgery is recommended within four months for persistent palsies, especially radial nerve injuries, to improve outcomes.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Trauma Surgery
Background:
- Supracondylar humerus fractures (SCHFs) are common in children.
- Up to 12% of pediatric SCHFs involve traumatic nerve injuries.
Purpose of the Study:
- To review evidence on managing traumatic nerve palsies following pediatric SCHFs.
- To guide clinicians on optimal timing for investigations and interventions.
Main Methods:
- Systematic review following Joanna Briggs Institute (JBI) and PRISMA guidelines.
- Independent review of 51 manuscripts.
- Data extraction, synthesis, and quality assessment.
Main Results:
- 510 traumatic nerve palsies in pediatric SCHFs were analyzed.
- 376 (73.7%) nerve palsies recovered spontaneously within ~19.5 weeks.
- 37 cases (7.3%) underwent surgical exploration at ~4 months for persistent deficits, most commonly due to nerve entrapment.
- 13 of 15 reported nerve lacerations involved the radial nerve.
Conclusions:
- Full recovery is common for pediatric nerve palsies associated with SCHFs.
- Surgical exploration should be considered within four months for delayed or absent recovery.
- Earlier exploration may be warranted for radial nerve palsies.
Abstract:
Purpose: Up to 12% of paediatric supracondylar humerus fractures (SCHFs) have an associated traumatic nerve injury. This review aims to summarize the evidence and guide clinicians regarding the timing of investigations and/or surgical interventions for traumatic nerve palsies after this injury. Methods: A formal systematic review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews and PRISMA guidelines. Manuscripts were reviewed by independent reviewers against the inclusion and exclusion criteria, and data extraction, synthesis, and assessment for methodological quality were undertaken. Results: A total of 51 manuscripts were included in the final evaluation, reporting on a total of 510 traumatic nerve palsies in paediatric SCHFs. In this study, 376 nerve palsies recovered without any investigation or intervention over an average time of 19.5 weeks. Comparatively, 37 went back to theatre for exploration beyond the initial treatment due to persistent deficits, at an average time of 4 months. The most common finding at the time of exploration was entrapment of the nerve requiring neurolysis. A total of 27 cases did not achieve full recovery regardless of management. Of the 15 reports of nerve laceration secondary to paediatric SCHFs, 13 were the radial nerve. Conclusions: Most paediatric patients who sustain a SCHF with associated traumatic nerve injury will have full recovery. Delayed or no recovery of the nerve palsy should be considered for exploration within four months of the injury; earlier exploration should be considered for radial nerve palsies.
