Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov-Dec;44(10):e871-e875.
doi: 10.1097/BPO.0000000000002793. Epub 2024 Oct 9.

In Supracondylar Humerus Fractures With Nerve Injury, Does Time to Surgery Impact Recovery?

Brian D Wahlig  1 , Mikaela H Sullivan, Samuel E Broida, A Noelle Larson, William J Shaughnessy, Anthony A Stans, Emmanouil Grigoriou, Todd A Milbrandt
Affiliations

In Supracondylar Humerus Fractures With Nerve Injury, Does Time to Surgery Impact Recovery?

Brian D Wahlig et al. J Pediatr Orthop. 2024 Nov-Dec.

Abstract

Background: Supracondylar humerus (SCH) fractures are common and present with associated nerve injuries in 11% to 42% of cases. Historically, SCH fractures with neurological compromise warranted urgent surgical intervention. A recent study showed that treatment delay is acceptable in patients with isolated anterior interosseous nerve (AIN) injury. Though indications for urgent treatment are relaxing, no studies have evaluated the need for urgent surgical treatment for other nerve injuries associated with SCH fractures. The aim of this study was to determine if the timing of surgical intervention is related to the timing of neurological recovery in SCH fractures associated with any nerve injury.

Methods: A retrospective review of 64 patients with surgically managed SCH fractures and concomitant neurological deficit on presentation was conducted at a single level 1 pediatric trauma hospital from 1997 to 2022. The relationship between the time to surgical intervention and the time to partial and complete nerve recovery was analyzed using linear regression.

Results: Sixty-four patients with an average age of 6.9±2.0 years and an average time to surgery of 9.8±5.6 hours were analyzed. Sixty-two patients (97%) were followed to partial neurological recovery and 36 (56%) were followed to full neurological recovery. Neurological deficit included median [n=41 (64%)], radial [n=22 (34%)], and ulnar [n=15 (23%)]. Ten patients (16%) had isolated AIN injury. The average time to partial neurological recovery was 20±23 days and the time to full recovery was 93±83 days. There was a statistically significant relationship between time to partial neurological recovery and time to surgical intervention (P=0.02). There was no relationship between time to full neurological recovery and time to surgery (P=0.8).

Conclusion: Earlier time to surgical intervention in pediatric SCH fractures with isolated nerve injury was associated with earlier partial recovery but not full neurological recovery. Prioritizing urgent surgery in these patients did not improve their ultimate neurological recovery.

Level of evidence: Therapeutic level III.

PubMed Disclaimer

Conflict of interest statement

A.N.L.: DePuy: research support, Globus Medical: research support, Medtronic: research support, Orthopediatrics: research support, POSNA: board/committee member, Scoliosis Research Society: board/committee member, Zimmer: research support. T.A.M.: AAOS: board/committee member, Broadwater: other financial support, Medtronic: paid consultant, Orthopediatrics: paid consultant, POSNA: board/committee member, Scoliosis Research Society: board/committee member, Viking Scientific: stock/stock options, Zimmer: paid consultant. The remaining authors declare no conflicts of interest.

References

    1. Baig MN. A review of epidemiological distribution of different types of fractures in paediatric age. Cureus. 2017;9:e1624.
    1. Culp RW, Osterman AL, Davidson RS, et al. Neural injuries associated with supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1990;72:1211–1215.
    1. Cramer KE, Green NE, Devito DP. Incidence of anterior interosseous nerve palsy in supracondylar humerus fractures in children. J Pediatr Orthop. 1993;13:502–505.
    1. Campbell CC, Waters PM, Emans JB, et al. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop. 1995;15:47–52.
    1. Lyons ST, Quinn M, Stanitski CL. Neurovascular injuries in type III humeral supracondylar fractures in children. Clin Orthop Relat Res. 2000;376:62–67.