Vascular and Neural Complications in Supracondylar Fractures of the Humerus in Children

Lipscomb, Paul R.; Burleson, R. Joe

doi:10.2106/00004623-195537030-00004

Cited by 108 publications

(56 citation statements)

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“…In case of posteromedial displacement of the distal fragment, the lateral structures are stretched over the proximal fragment and vice versa. Correspondingly, clinical studies confirm predilection for extension-type fractures with posterolateral displacement to injure the median nerve, anterior interosseous nerve and/or the brachial artery and fractures with posteromedial displacement to involve the radial nerve and/or posterior interosseous nerve [9,18,34,58,60]. Neurologic deficits seem to be more common in posteromedially displaced fractures [5,63].…”

Section: Nerve Lesions (Excluding Iatrogenic Lesions See Complications)mentioning

confidence: 84%

“…With rare exceptions, concomitant nerve lesion in displaced supracondylar fracture recovers spontaneously. Recovery time ranges from 1-4 months with an average of 2-3 months [15,21,28,30,33,51,58,63,73,93]. In a metaanalysis of anterior interosseous nerve syndromes, all 34 patients regained full flexion and strength within 4-17 weeks after trauma [48].…”

Section: Nerve Lesions (Excluding Iatrogenic Lesions See Complications)mentioning

confidence: 99%

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Supracondylar Fractures of the Humerus in Children

Hasler

2001

Eur J Trauma

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Closed reduction and percutaneous pinning techniques for displaced supracondylar fractures of the humerus in children (Gartland type III) have overcome disastrous ischemic complications and long inpatient treatment. Closed reduction of those highly unstable fractures and the demanding pin placement itself are potential sources of failure for the inexperienced reflected by the rate of cubitus varus which is still about 5-15% in recent series. Rotational primary and residual displacement has to be appreciated to prevent permanent cosmetic deformity. Malrotation is the major source of instability since bicolumnar support is lost which allows the distal fragment to tilt. Biomechanically tested better stability of crossed medial and lateral pins in comparison to two parallel lateral pins does not seem to be of practical importance. The risk of ulnar nerve injury by medial-pin fixation is not outweighed by significantly better clinical result. The rate of iatrogenic nerve injuries is 3-16% with the ulnar nerve being the most susceptible due to inadvertent pinning. Despite a high recovery rate, they are a nuisance for the patients. Fracture-related peripheral neuropathies have an incidence of 10-17%. With rare exceptions, concomitant nerve lesion recover spontaneously within a time range of 1-4 months. There is still controversy regarding the management of a post reduction pink, warm but pulseless hand with adequate capillary refill. Simple observation and conservative management lead to a favorable clinical outcome in most cases but cold intolerance or exercise-induced ischemic symptoms are a potential sequel.

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Section: Nerve Lesions (Excluding Iatrogenic Lesions See Complications)mentioning

confidence: 84%

Section: Nerve Lesions (Excluding Iatrogenic Lesions See Complications)mentioning

confidence: 99%

Supracondylar Fractures of the Humerus in Children

Hasler

2001

Eur J Trauma

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“…요골 신경, 척골 신경, 및 정중 신경 모두 손상 받을 수 있으며 6,12) , Spinner와 Schreiber 19) 는 전골간 신경손상을 보고한 바 있다. 전위된 상완골 과 상부 골절시 일차적인 신경손상이 약 20% 2,6,21) , 인위적 인 신경 손상은 2-3% 14) , 수상 후 요골 동맥이 촉지 되지 않는 경우는 19% 정도 이르는 것으로 보고되었다 …”

Section: 서 론unclassified

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

Kim

Jung

2008

J Korean Orthop Assoc

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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.

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“…Der Nachteil dieses Vorgehens liegt im Verlust der Stabilität der Osteosynthese [2,19]. Dies wiederum begünstigt eine sekundäre Dislokation, die dann bei vollständigem Abkippen des ulnaren Pfeilers entweder zu einem Therapiewechsel führt oder -nicht erkannt -in einem Cubitus varus endet [3,5,6,8,10,12,14,16].…”

Section: Schlüsselwörterunclassified