Abstract
The supracondylar humerus fracture (SCHF) in children is common and can be complicated with nerve injury either primarily immediate post-trauma or secondarily posttreatment. The concept of neurapraxic nerve injury makes most surgeons choose to ‘watch and see’ the nerve recovery before deciding second surgery if the nerve does not recover. We report three cases of nerve injury in SCHF, all of which underwent nerve exploration for different reasons. Early reduction in the Casualty is important to release the nerve tension before transferring the patient to the operation room. If close reduction fails, we proceed to explore the nerve together with open reduction of the fracture. In iatrogenic nerve injury, we recommend nerve exploration to determine the surgical procedure that is causing the injury. Primary nerve exploration will allow early assessment of the injured nerve and minimize subsequent surgery.
Highlights
The supracondylar humerus fracture (SCHF) is one of the most common fractures in children, predominantly the extension-type
As the Median and Radial Nerves lie anterior to the supracondylar humerus region they are at risk for injury, primarily post-trauma either by stretching, piercing or impinging at the fracture ends or being entrapped between two fracture fragments, whereas the Ulnar Nerve injury is usually secondary to treatment 1
On suspicion of an iatrogenic Ulnar Nerve injury, we explored the nerve and found the medial wire impinging on the nerve (Fig. 3B) and after removal of the medial K-wire we noted an intra-neural blackish segment that could be intra-neural ischaemia or intra-neural hematoma (Fig 3C)
Summary
The supracondylar humerus fracture (SCHF) is one of the most common fractures in children, predominantly the extension-type. As the Median and Radial Nerves lie anterior to the supracondylar humerus region they are at risk for injury, primarily post-trauma either by stretching, piercing or impinging at the fracture ends or being entrapped between two fracture fragments (traumatic or primary nerve injury), whereas the Ulnar Nerve injury is usually secondary to treatment (iatrogenic or secondary nerve injury) 1. In the extension-type of SCHF, postero-medial displacement of distal fragment usually causes injury to the Radial Nerve and postero-lateral placement is more likely to cause Median Nerve injury. In the flexion-type of SCHF, the Ulnar Nerve injury predominates 2. For the medial placement of the Kirschner-wire (K wire), the mini-open technique has been proposed in order to minimize injury to the Ulnar Nerve. We discuss three cases of nerve injury in SCHF which underwent nerve exploration for different reasons
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
