We evaluated the management of supracondylar paediatric fractures at our institution over a 10-year period in this retrospective cohort study. In total, 762 children with a supracondylar fracture were treated. The mean age of injury was 5.2 years. The incidence of documented nerve and/or vascular injury was 8.3%. A total of 26 patients had early plastic surgeon involvement; of these, 25 had an open exploration. Eight patients required vein grafting for brachial artery reconstruction for intimal tears. There was one nerve rupture requiring repair and 12 children underwent neurolysis. There were 17 late referrals to the plastic surgery service, of which three were explored (two neurolysis, one neuroma resection and sural nerve grafting). In all cases of nerve injury, the deficit took 7.9 months to recover, indicating a more significant injury than neurapraxia. Early exploration of supracondylar fractures allows direct visualization of the extent of neurovascular injury and immediate intervention.
BabalJCMehlmanCTKleinG.Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010,
30: 253–63.
2.
BirchRAchanP. Peripheral nerve repairs and their results in children. Hand Clin. 2000, 16: 579–95.
3.
BirchR. Surgical disorders of the peripheral nerves. Springer Science & Business Media, 2011.
4.
BlakeyCMBiantLCBirchR.Ischaemia and the pink, pulseless hand complicating supracondylar fractures of the humerus in childhood: long-term follow-up. J Bone Joint Surg Br. 2009,
91: 1487–92.
5.
BrauerCALeeBMBaeDSWatersPMKocherMS.A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop. 2007,
27: 181–6.
CampbellCCWatersPMEmansJBKasserJRMillisMB.Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop. 1995,
15: 47–52.
8.
ChengJCLamTPMaffulliN.Epidemiological features of supracondylar fractures of the humerus in Chinese children. J Pediatr Orthop B. 2001,
10: 63–7.
9.
CulpRWOstermanALDavidsonRSSkirvenTBBoraFWJr.Neural injuries associated with supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1990,
72: 1211–5.
10.
ErsanOGonenEIlhanRDBoysanEAtesY.Comparison of anterior and lateral approaches in the treatment of extension-type supracondylar humerus fractures in children. J Pediatr Orthop B. 2012,
21: 121–6.
11.
GartlandJ.Management of supracondylar fractures in children. Surg Gynecol Obstet. 1959,
109: 145–54.
12.
HumphreyJDimascioLMarcheseMSinisiM.Late presentation of a partial median nerve palsy following a Gartland III supracondylar humeral fracture. Acta Orthop Belg. 2012,
78: 267–70.
13.
KamathAFBaldwinKHorneffJHosalkarHS.Operative versus non-operative management of pediatric medial epicondyle fractures: a systematic review. J Child Orthop. 2009,
3: 345–57.
14.
KazimogluCAkcayS.Comment on nerve injuries in supracondylar fractures of the humerus in children: is nerve exploration indicated. J Pediatr Orthop. Part B. 2013,
22: 397.
15.
KocherMSKasserJRWatersPMet al.
Lateral entry compared with medial and lateral entry pin fixation for completely displaced supracondylar humeral fractures in children: a randomized clinical trial. J Bone Joint Surg Am. 2007,
89: 706–12.
16.
KwokIHSilkZMQuickTJSinisiMMacQuillanAFoxM.Nerve injuries associated with supracondylar fractures of the humerus in children: our experience in a specialist peripheral nerve injury unit. Bone Joint J. 2016,
98: 851–6.
17.
LandinLA.Epidemiology of children’s fractures. J Pediatr Orthop B. 1997,
6: 79–83.
18.
LewineEKimJMMillerPEet al.
Closed versus open supracondylar fractures of the humerus in children: a comparison of clinical and radiographic presentation and results. J Pediatr Orthop. 2018,
38: 77–81.
19.
MahanSTOsbornEBaeDSet al.
Changing practice patterns: the impact of a randomized clinical trial on surgeons’ preference for treatment of type 3 supracondylar humerus fractures. J Pediatr Orthop. 2012,
32: 340–5.
20.
MangatKSMartinAGBacheCE.The ‘pulseless pink’ hand after supracondylar fracture of the humerus in children: the predictive value of nerve palsy. J Bone Joint Surg Br. 2009,
91: 1521–5.
21.
MangwaniJNadarajahRPatersonJMH.Supracondylar humeral fractures in children – ten years’ experience in a teaching hospital. J Bone Joint Surg Br. 2006,
88: 362–5.
22.
OhCWParkBCKimPTParkIHKyungHSIhnJC.Completely displaced supracondylar humerus fractures in children: results of open reduction versus closed reduction. J Orthop Sci. 2003,
8: 137–41.
23.
PonceBAHedequistDJZurakowskiDAtkinsonCCWatersPM.Complications and timing of follow-up after closed reduction and percutaneous pinning of supracondylar humerus fractures: follow-up after percutaneous pinning of supracondylar humerus fractures. J Pediatr Orthop. 2004,
24: 610–4.
24.
RamachandranMBirchREastwoodDM.Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children: the experience of a specialist referral centre. J Bone Joint Surg Br. 2006,
88: 90–4.
25.
ReitmanRDWatersPMillisM.Open reduction and internal fixation for supracondylar humerus fractures in children. J Pediatr Orthop. 2001,
21: 157–61.
26.
ShoreBJGillespieBTMillerPEBaeDSWatersPM.Recovery of motor nerve injuries associated with displaced, extension-type pediatric supracondylar humerus fractures. J Pediatr Orthop. 2019,
39: e652–6.
27.
Tunku-NazihaTZWan-YuhanaWMHadizieD.Early vessels exploration of pink pulseless hand in Gartland III supracondylar fracture humerus in children: facts and controversies. Malaysian Orthop J. 2017,
11: 12.
WellerAGargSLarsonANet al.
Management of the pediatric pulseless supracondylar humeral fracture: is vascular exploration necessary?J Bone Joint Surg Am. 2013,
95: 1906–12.
30.
WhiteLMehlmanCTCrawfordAH.Perfused, pulseless, and puzzling: a systematic review of vascular injuries in pediatric supracondylar humerus fractures and results of a POSNA questionnaire. J Pediatr Orthop. 2010,
30: 328–35.
