The Role of Nerve Exploration in Supracondylar Humerus Fracture in Children with Nerve Injury

Anuar, Rim; Gooi, SG; Zulkiflee, O

doi:10.5704/moj.1511.019

Cited by 7 publications

(1 citation statement)

References 5 publications

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“…Both the studies showed no significant improvement in nerve complications. It should also be borne in mind that the documented incidence of primary nerve injury in these fractures is 7-10% and up to 6% for secondary nerve injury and the indication for intervention in these two distinct nerve injury pattern is different (3).…”

Section: Original Paper Původní Prácementioning

confidence: 99%

A Meta-Analysis on Comparison of Open vs Closed Reduction of Gartland Type 3 Supracondylar Humerus Fractures in Children

Barik¹,

Garg²,

SINHA³

et al. 2023

ACHOT

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PURPOSE OF THE STUDYAlthough there are numerous studies on outcomes and comparison of open and closed reduction but there is no clarity on relationship between outcomes and complications with type of surgical intervention done for Type 3 Gartland supracondylar humerus fracture. The aim of this study is to compare the outcomes and complications of closed vs open reduction in Type 3 Gartland supracondylar humerus fractures. MATERIAL AND METHODSElectronic literature searches of Embase, MEDLINE and the Cochrane Library was conducted in February 2022 using the terms "supracondylar", "humerus", "fracture", "Gartland type 3" and synonymous. The data extracted included the study details, demographic data, procedure performed, final functional and cosmetic outcome according to Flynn criteria and complications of included studies. RESULTSPooled data analysis revealed no significant difference in mean satisfactory outcome rate according to Flynn cosmetic criteria in open group (97%, 95% CI 95.5%-98.5%), as compared to closed group (97.5%, 95% CI 96.3%-98.7%), although a statistically significant difference in mean satisfactory rate according to Flynn functional criteria in open group (93.4%, 95% CI 90.8%-96.1%) as compared to closed group (98.5%, 95% CI 97.5%-99.4%) was noted. On separate comparison of the two-arm studies, closed reduction favoured better functional outcomes (RR 0.92, 95% CI 0.86-0.99). CONCLUSIONSClosed reduction and percutaneous fixation have better functional outcome than open reduction with K-wire fixation. But there was no significant difference in cosmetic outcomes, overall complication rate and nerve injury with either open or closed reduction. The threshold of converting a closed reduction to an open reduction in supracondylar humerus fractures of children should be high.

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Section: Original Paper Původní Prácementioning

confidence: 99%

A Meta-Analysis on Comparison of Open vs Closed Reduction of Gartland Type 3 Supracondylar Humerus Fractures in Children

Barik¹,

Garg²,

SINHA³

et al. 2023

ACHOT

View full text Add to dashboard Cite

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Radial nerve trapped posterior to the proximal fracture end after closed reduction of supracondylar humerus fracture in children: A case report

Wang

et al. 2022

International Journal of Surgery Case Reports

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Radiological and biomechanical evaluation of the ulnar nerve after the percutaneous application of the medial K-wire in the extended position on supracondylar humerus fractures: Does the postoperative long arm splint position matter?

Çeltik,

Özkan,

Hapa

et al. 2024

Medicine

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Our study aimed to evaluate and compare the changes in ulnar nerve tension and strain at different elbow positions radiologically and mechanically before and after applying the medial K-wire on the supracondylar humerus fracture cadaver model. We used ten fresh frozen cadaver upper extremity specimens to measure strain and tension on the ulnar nerve in 3 different elbow positions: elbow full extension, elbow flexion–forearm supination, and elbow flexion–forearm pronation. We employed Shear wave elastography (Siemens Acuson S3000 USG, 9L4 linear probe) and a microstrain gauge (Microstrain, Inc., Burlington) to obtain our measurements. Minimum, maximum and mean stress and strain values on the nerve and its surroundings were measured and compared statistically. The mean values of elbows with full extension are statistically lower than those in elbows with 90° flexion–forearm supination and those with 90° flexion–forearm pronation positions. Statistical evaluations were performed between all of the groups. Elbow 90° flexion–forearm pronation, both minimum and maximum and mean values were statistically higher in the group, including the specimens with Kirschner applied. The mean values in the elbow full extension and elbow 90° flexion–forearm supination positions were statistically similar in the specimens with and without the K-wire applied. Despite the numerous techniques described in the literature, there is no absolute technical method to prevent ulnar nerve damage. K-wire application to the medial epicondyle with the elbow in a slightly extended position is a technique that can be applied to reduce the risk of ulnar nerve paralysis. However, it has been reported that ulnar nerve damage can be observed in cases where a splint is placed in the 90° flexion position. We hypothesize that the position of the elbow joint in the postoperative period may contribute to ulnar nerve paralysis due to soft tissue tension and strain and as a result of changing the balance of the surrounding tissues. Our findings suggest that the long arm splint applied in elbow 90° flexion and forearm pronation position should not be preferred in the postoperative period. The maximum strain values obtained in the elbow full extension were lower, suggesting that it would be appropriate to stabilize the elbow in the extension position as much as possible postoperatively. Level of evidence: Level V.

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The Role of Nerve Exploration in Supracondylar Humerus Fracture in Children with Nerve Injury

Cited by 7 publications

References 5 publications

A Meta-Analysis on Comparison of Open vs Closed Reduction of Gartland Type 3 Supracondylar Humerus Fractures in Children

A Meta-Analysis on Comparison of Open vs Closed Reduction of Gartland Type 3 Supracondylar Humerus Fractures in Children

Radial nerve trapped posterior to the proximal fracture end after closed reduction of supracondylar humerus fracture in children: A case report

Radiological and biomechanical evaluation of the ulnar nerve after the percutaneous application of the medial K-wire in the extended position on supracondylar humerus fractures: Does the postoperative long arm splint position matter?

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