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Structured Motor Rehabilitation After Selective Nerve Transfers

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In Supracondylar Humerus Fractures With Nerve Injury, Does Time to Surgery Impact Recovery?

Brian D Wahlig¹, Mikaela H Sullivan, Samuel E Broida

¹Mayo Clinic Department of Orthopedic Surgery, Rochester, MN.

Journal of Pediatric Orthopedics

|October 28, 2024

Summary

Urgent surgery for pediatric supracondylar humerus fractures with nerve injury may lead to earlier partial nerve recovery, but does not impact full neurological recovery. Prioritizing rapid surgical intervention is not essential for optimal outcomes.

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Published on: September 7, 2022

Area of Science:

Pediatric Orthopedics
Trauma Surgery
Neurology

Background:

Supracondylar humerus (SCH) fractures frequently involve nerve injuries.
Historically, urgent surgery was indicated for neurological compromise.
Recent evidence suggests delayed treatment may be acceptable for isolated anterior interosseous nerve (AIN) injuries.

Purpose of the Study:

To investigate the relationship between surgical intervention timing and neurological recovery in pediatric SCH fractures with nerve injuries.
To determine if urgent surgery improves ultimate neurological recovery in these cases.

Main Methods:

Retrospective review of 64 pediatric patients with surgically managed SCH fractures and neurological deficits.
Analysis of the correlation between time to surgery and time to partial/full nerve recovery using linear regression.
Data collected from a single level 1 pediatric trauma center between 1997 and 2022.

Main Results:

A significant relationship was found between earlier surgical intervention and earlier partial neurological recovery (P=0.02).
No significant relationship was observed between surgical timing and full neurological recovery (P=0.8).
Median, radial, and ulnar nerve deficits were most common; 16% had isolated AIN injury.

Conclusions:

Earlier surgical intervention in pediatric SCH fractures with nerve injuries is associated with faster partial recovery.
Urgent surgery does not appear to enhance the extent of ultimate neurological recovery.
The findings suggest that prioritizing immediate surgery may not be necessary for optimal neurological outcomes in these fractures.