Neurologic recovery of neural injuries associated with supracondylar fractures of the humerus in children

Yoon, Hyung Ku; Jeon, Seoung Ju; Jun, Ho Seung; Cho, Kye Nam; Kang, Chul Won

Abstract

PURPOSE
: The purpose of our study in to determine the incidence of spontaneous recovery from neural injuries associated with supracondylar fractures of the humerus and to assess the results of electromyographic study and nerve conduction velocity. Material & methods : The 160 displaced supracondylar fractures of the humerus which had operation at the Sung Ae general hospital between April 1994 and 1998 were reviewed. Twelve(7.5%) were associated with complete neural injuries involving 16 nerves ; 9 radial, 5 ulnar and 2 median nerves. The mean age was 7.8 years old and boys outnumbered girls by 9 to 3. The follow-up period ranged from 1 year to 5 yeras 2 months. 11 fractures were managed with closed reduction and one with open means. All of the neural injuries were initially managed only by closed observation. At recent follow-up examination, we assessed the motor and sensory neurological status with Seddon's modification, grip strength and two-point discrimination in the autonomous zone. Electromyography(EMG) and nerve conduction velocity(NCV) were performed in 13 nerves of 10 patients who were assessed as complete recovered clinically. Result : Spontaneous neurological recovery occurred in 11 patients(15 nerves) at a mean of 2.4 months(range, 2 to 3.5 months.) Clinically, these nerves were assessed as normal. In the EMG and NCVs, 4 of 13 nerves resulted in adnormal findings. 2 radial and 1 ulnar nerve showed mild sensory neuropathy and 1 ulnar nerve showed mild denervation potentials in EMG and slow motor and sensory NCVs.
CONCLUSION
: We think that neural injuries associated with the displaced supracondylar fractures of the humerus tend towards spontaneous recovery within 4 months. And even though the neurologic recoveries are clinically complete, these are not always completely recovered in electromyographic study and nerve conduction velocity.