Prevalence of ulnar nerve palsy with flexion-type supracondylar fractures of the humerus

Abstract

The aim of this study is to report the rate and type of neurologic injury associated with flexion supracondylar fractures at a tertiary, university institution treated over a 10-year period. All supracondylar humerus fracture cases treated at our institution between January 2004 and January 2014 were retrospectively reviewed. Twenty-three flexion-type fractures were identified. Patient demographics as well as fracture classification, treatment modalities, and pre-and post-treatment neurologic status were analyzed. Twenty-three flexion-type supracondylar humerus fractures were identified and reviewed out of a total of 1000 supracondylar humerus fractures (2.3%). Details of the patients’ neurologic status upon presentation demonstrated that 17 (74%) patients were intact and six (26%) patients presented with an ulnar neuropraxia. Zero type I fractures, one type II fractures (14.3%), and five type III fractures (33.3%) demonstrated an ulnar nerve palsy. Of these, all six nerve deficits resolved following treatment. One additional patient was identified with median nerve neuropraxia following treatment with closed reduction casting, which resolved following observation. A total of 4 (17.4%) patients were treated with closed reduction casting, 15 (65.2%) with closed reduction percutaneous pinning, and four (17.4%) with open reduction internal fixation. Flexion-type supracondylar fractures of the humerus are rare yet significant injuries. The 26% of patients who developed an ulnar neuropraxia following a displaced flexion supracondylar fracture were higher than previous studies reported in the literature. This increased prevalence may be due to the high rates of type III fractures reported in the current study. Level of evidence: III, Retrospective comparative cohort analysis.

Incidence of flexion‐type supracondylar fractures at a single Australian level one Paediatric Trauma Centre

“…Fractures were classified as either extension or flexion-type by referring to the position of the anterior humeral line and anterior or posterior fracture displacement. As per previous studies including those by De Boeck, 8 Garg et al 4 and Kim et al 2 the flexion-type supracondylar fractures were then graded according the Modified Gartland Classification System; Type I is minimally displaced, Type II is displaced with some integrity of anterior cortex and Type III is displaced with no cortical contact. 2,4,8 Patient demographic data including age and sex was then collected for all supracondylar fractures.…”

“…As per previous studies including those by De Boeck, 8 Garg et al 4 and Kim et al 2 the flexion-type supracondylar fractures were then graded according the Modified Gartland Classification System; Type I is minimally displaced, Type II is displaced with some integrity of anterior cortex and Type III is displaced with no cortical contact. 2,4,8 Patient demographic data including age and sex was then collected for all supracondylar fractures. To allow further analysis of flexion-type fractures, additional data collected for these injuries included mechanism of injury, fracture characteristics, neurovascular status, initial and operative management, complications, and follow-up.…”

“…Supracondylar fractures are the most common elbow fracture in the paediatric population. 1,2 They account for 15% of all paediatric fractures 3 and are the second most common fracture in childhood. The majority of these are extension-type fractures (up to 98%) commonly caused by falling onto an outstretched hand.…”

“…The majority of these are extension-type fractures (up to 98%) commonly caused by falling onto an outstretched hand. 2 In contrast, the much less common flexion-type supracondylar fractures usually result from a direct fall on the elbow, leading to anterior angulation of the distal fragment which places the ulnar nerve at risk. 3,4 Studies, including Flynn et al 1 suggest that flexion-type supracondylar fractures are a more significant injury than extension-type fractures.…”

“…Higher rates of open reduction internal fixation in flexion-type frac-tures 1,3 have been reported, as well as higher rates of complications such as ulnar nerve palsies. 1,3 As flexion-type supracondylar fractures account for only two to 10 % of all supracondylar fractures, literature analysing these injuries 2,3,5,6 especially regarding the recovery of any nerve palsies is extremely limited. A review study by Sharma 6 highlights the variation in incidence of flexion-type supracondylar fractures with incidence documented between one and 10%, however does not elaborate on this.…”