J Korean Orthop Assoc.  2008 Apr;43(2):240-246. 10.4055/jkoa.2008.43.2.240.

Neuro-vascular Injuries Associated with Supracondylar Fractures of the Humerus in Children

• Kim JR
• Jung WC

• KMID: 2106446
• DOI: http://doi.org/10.4055/jkoa.2008.43.2.240

Abstract

PURPOSE: Supracondylar fractures in children have the potential for associated neuro-vascular injuries. It is important to diagnose and manage these fractures because they are often underestimated when assessing a painful elbow in agitated children. This study focused on evaluating the frequency of neuro-vascular injuries associated with fracture displacement, and to define a therapeutic strategy.
MATERIALS AND METHODS
From January 1997 to December 2006, 128 children who were available to follow up were examined restrospectively. The incidence of neuro-vascular injuries was investigated, and the types and displacement of fractures were classified. The therapeutic strategy and complications were also defined.
RESULTS
Neuro-vascular complications occurred in 24 patients. Seventeen, 12, 4, 4 and 1 patient had only neural injuries, radial, ulnar, median, and anterior interosseous nerve. There were 4 patients with both neural and vascular injuries, and 3 patients had only vascular injuries. Most neural injured patients had recovered completely, but 1 patient had not recovered after 6 months. Therefore, exploration and sural nerve graft was performed.
CONCLUSION
The frequency of neuro-vascular injury is a result of severely displaced supracondylar fracture. A therapeutic strategy for supracondylar fractures in children is proposed to minimize complications.

Keyword

Children; Humerus; Supracondylar fracture; Displacement; Neuro-vascular injury

MeSH Terms

Child
Dihydroergotamine
Displacement (Psychology)
Elbow
Follow-Up Studies
Humans
Humerus
Incidence
Organic Chemicals
Sural Nerve
Transplants
Vascular System Injuries
Dihydroergotamine
Organic Chemicals

Figure

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  Fig. 1 (A) In a six-year-old boy presented with severe swelling of right upper arm, and the raidal pulse was absent in the emergency room. (B) Anteroposterior and (C) lateral radiograph shows Gartland's type 3A (postero-lateral displacement): involvement of the brachial artery by humeral spike. (D) Exposing the fracture through an anteromedial approach allows visualization of the impingement of the brachial artery (arrow) by the meidal spike. (E-G) One year after surgery, the result was excellent without any sequela.

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  Fig. 2 Management strategy with supracondylar fracture of the humerus and neurologic deficit. CRPP, closed reduction and percutaneous pinning; EMG, Electromyogram.

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  Fig. 3 Management of supracondylar fracture of the humerus fracture with vascular compromise. CRPP, closed reduction and percutaneous pinning.

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