8/13/2019 Jou Read

1/21

Nerve Injuries Associated With PediatricSupracondylar Humeral Fractures

Jessica C. Babal, BS,Charles T. Mehlman, DO,MPH, and Guy Klein, BS

8/13/2019 Jou Read

2/21

8/13/2019 Jou Read

3/21

8/13/2019 Jou Read

4/21

8/13/2019 Jou Read

5/21

8/13/2019 Jou Read

6/21

8/13/2019 Jou Read

7/21

INTRODUCTION

Supracondylar fracture ot the humerus :The most common type of elbow fracture inchildren

Type :1. Extension (96% - 98%)

2. Flexion (2% - 4%)

8/13/2019 Jou Read

8/21

8/13/2019 Jou Read

9/21

Treatment standard is reduction bypercutaneous pin fixation.

Highest ranks of nerve injury :a. Extension-type : radial nerve (greatest

risk for neurapraxia)

b. Flexion-type : rare risk

8/13/2019 Jou Read

10/21

METHODS

Collect data from PubMed MEDLINE (1950 July 2009) for terms supracondylar humerus

or supracondylar fracture, and CochraneDatabase (1800 July 2009) using termssupracondylar.

8/13/2019 Jou Read

11/21

Total data 5148 patients Data for traumatic neurapraxia divided into :

1. Displaced extension-type supracondylarhumerus

2. Displaced flexion-type fracture ofsupracondylar humerus

8/13/2019 Jou Read

12/21

Data iatrogenic nerapraxia caused by closereduction and percutaneous pinning dividedinto :

1. Neurapraxia induced by Lateral onlypinning

2. Neurapraxia induced by the use of at leastone medial pin

8/13/2019 Jou Read

13/21

Meta-analysis was performed usingcomprehensive Meta-analysis v2.0(Biostat, Englewood, NJ).

They used Fishers exact test

8/13/2019 Jou Read

14/21

RESULT

From 5148 patients, traumatic neurapraxia for alldisplaced pediatric supracondylar fractures of thehumerus was 11,3% Median Anterior interosseous Radial nerve injuries Posterior interosseous Ulnar

4,6%

8/13/2019 Jou Read

15/21

Extension-type with traumatic neurapraxia :

Median Anterior interosseous Radial nerve injuries

Posterior interosseous Ulnar

Flexion-type with traumatic neurapraxia : Median Ulnar

34,1%

91,3%

nerve injuries

8/13/2019 Jou Read

16/21

8/13/2019 Jou Read

17/21

Lateral pinning increased risk of mediannerve injury as compared with medialpinning (p=0,043)

Medial pinning increased risk of ulnar nerveinjury (p=0,027)

8/13/2019 Jou Read

18/21

DISCUSSION

Neurapraxia is the most commoncomplication

In large studies radial nerve as the mostcommon neurapraxia

In other studies anterior interosseous asthe most commonneurapraxia

8/13/2019 Jou Read

19/21

Campbell et al anterior interosseousnerve injury as the most common inextension-type fracture the supracondylar

humerus.

Mahan et al, Fowles and Kassabincreased risk of nerve injury in flexionfracture compared with extension fracture

8/13/2019 Jou Read

20/21

8/13/2019 Jou Read

21/21