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Rock-paper-scissors-OK game for neurological examination in pediatric supracondylar humerus fractures: A prospective
Tahsin Aydin1, Fatih Inci1, Muhammed Kilic1
1Department of Orthopaedics and Traumatology, Ankara Bilkent City Hospital Universiteler Mahallesi, Cankaya, Ankara, Turkey.
Insights
A smartphone game improved pediatric nerve examinations after surgery for humerus fractures. This method increased patient satisfaction and communication, making postoperative assessments more efficient.
Area of Science:
- Pediatric Orthopedics
- Pediatric Surgery
- Neurology
Background:
- Pediatric supracondylar humerus fractures often involve nerve injuries.
- Assessing these nerve injuries pre- and post-operatively can be challenging in children.
- Objective evaluation of nerve function is crucial for surgical outcomes.
Purpose of the Study:
- To evaluate a smartphone application designed to teach nerve examinations to children using a game.
- To assess the impact of this app on nerve examination time and patient/parent satisfaction.
- To compare a game-based approach with the traditional teaching method.
Main Methods:
- A prospective randomized controlled study involving 102 children (aged 4-10) undergoing surgery for supracondylar humerus fractures.
- Children were randomized into two groups: traditional teaching versus smartphone application with a rock-paper-scissors-OK game.
- Nerve examination times (pre- and post-operative) and child/parent satisfaction (using Child HCAHPS) were recorded.
Main Results:
- While preoperative examination was faster with the traditional method, postoperative examination was quicker using the smartphone app (12.2 min vs. 4.3 min).
- Children using the app showed better adaptation, reduced agitation, crying, and noncompliance.
- Satisfaction scores were higher for "Communication with Doctors" and "Keeping You Informed" in the app group.
Conclusions:
- A smartphone-based game significantly enhances postoperative nerve examination efficiency in pediatric patients.
- The game-based approach improves patient satisfaction, particularly in communication and information delivery.
- This innovative method offers a promising alternative for pediatric nerve examination assessment.
Purpose:
Pediatric supracondylar humerus fractures frequently involve nerve injuries, which can be difficult to assess before and after surgery. This study evaluated a smartphone application that teaches nerve examination to children using a rock-paper-scissors-OK game, and assessed its effects on examination time and satisfaction.
Methods:
In this single-center, prospective randomized controlled study, 102 children aged 4-10 years who underwent surgical treatment were randomized into 2 groups. Group 1 learned nerve examination through the classical method taught by orthopedic residents and a specialist. Group 2 was taught using the smartphone application with the game. Pre- and postoperative nerve examination times were recorded. Child and parent satisfaction were measured with the Child HCAHPS questionnaire.
Results:
Mean preoperative examination time was shorter in group 1 (4.3 ± 1.3 min) (p = 0.036), while postoperative time was shorter in group 2 (12.2 ± 2.4 min; p = 0.041). Although the app-based method took longer preoperatively, children in group 2 adapted better, enabling faster postoperative assessments. Agitation, crying, and noncompliance were less frequent in the game-assisted group. Satisfaction scores were higher in group 2 for "Communication with Doctors" (p = 0.032) and "Keeping You Informed" (p = 0.041), with no differences in other domains. Temporary nerve deficits occurred at similar rates and resolved spontaneously in all cases.
Conclusions:
A smartphone-based rock-paper-scissors-OK game improves postoperative nerve examination efficiency and increases satisfaction, particularly regarding communication and information sharing.
Level Of Evidence:
Level II.
Trial Registration:
ClinicalTrials.gov identifier NCT07480798; retrospectively registered on 16 March 2026, after study initiation on 13 March 2024(Supplemental Material 1).
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