Nerve Injuries in Supracondylar Humeral Fractures in Children

Česká verzia

Authors: R. Štichhauer ¹; J. Preis ¹; M. Kanta ²; J. Krobot ³
Authors place of work: Oddělení dětské chirurgie a traumatologie Centrum dětské traumatologie FN Hradec Králové ¹; Neurochirurgická klinika LF UK a FN Hradec Králové ²; LF UK v Hradci Králové ³
Published in the journal: Cesk Slov Neurol N 2017; 80/113(4): 440-444
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2017440

Summary

Aim:
To determine the incidence, percentage, possibilities of examination and treatment of peripheral nerve injuries in supracondylar humerus fractures in children.

Methods:
A retrospective study of patients with peripheral nerve injury in supracondylar fractures treated at the Department of Paediatric Surgery and Traumatology, University Hospital Hradec Králové in 2008–2015.

Results:
During this period, among the total of 786 patients with supracondylar humerus fractures requiring surgical treatment, concurrent peripheral nerve injury was identified in 59 patients, most frequently n. medianus (57.6%) and n. ulnaris (23.7%). The overall incidence of the isolated n. ulnaris injury (4.6%) corresponded with the published data. Acute treatment of peripheral nerve injury was mostly conservative, more than 37% of nerve lesions recovered within 1 month from the accident, after 6 months the percentage of recovered cases was almost 80%. In two cases (3.4 %), it was necessary to perform microsurgical deliberation of the fixed nerve from the fracture callus 4 months after the injury. Three patients had minor permanent paresthesias.

Conclusion:
Peripheral nerve injuries are a common complication of supracondylar humerus fractures in children. The majority of injuries were neuropraxia or axonotmesis receding after adequate conservative treatment. No immediate operative revision or suture was performed in any patient. Surgical deliberation of the peripheral nerve was performed in two cases 4 months after the primary injury. We did not notice a higher incidence of the ulnar nerve injury in the cross-pinning type of osteosynthesis compared to commonly published data on other methods of fixation. None of the patients have permanent consequences affecting their everyday life.

Key words:
supracondylar humerus fracture – peripheral nerve injury – K-wires pinning – neurapraxia – axonotmesis – neurolysis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Chinese summary - 摘要

儿童肱骨髁上骨折伴神经损伤

目标：

确定儿童肱骨髁上骨折伴周围神经损伤的发病率，百分比以及检查和治疗的可能性。

方法：

这是一项回顾性研究，研究对象包括2008 - 2015年期间在赫拉德茨·克拉洛韦大学医院小儿外科和创伤科受治疗的肱骨髁上骨折伴周围神经损伤患者

结果：

在此期间，共有786例肱骨髁上骨折患者需要手术治疗，其中59例患者伴有周围神经损伤， 57.6％患者发生在正中部和23.7％发生在尺侧。单独的尺骨损伤的总发病率（4.6％）符合公布的数据。大多数周围神经损伤急性治疗为保守治疗，病情发生后1个月内有37％以上的神经损伤得到恢复，6个月后恢复的比例接近80％。其中有两例患者（3.4％）需要在损伤后4个月对骨折愈伤组织进行显微外科手术。还有三名患者有轻微的永久性感觉异常。

结论：

周围神经损伤是儿童肱骨髁上骨折的常见并发症。大多数损伤属于神经失用或轴突中断，经过适当的保守治疗会有缓解。没有任何患者进行立即手术修复或缝合，但在原发性损伤4个月后，进行了两例外周神经的外科手术。同其它固定方法的公开数据相比，我们没有发现交叉钉扎类型的骨缝合术中尺骨神经损伤的发病率更高。没有任何患者的日常生活受到永久性影响。

关键词：

肱骨髁上骨折 - 周围神经损伤 - 克氏针固定 - 神经失用症 - 轴突中断 - 神经松解术

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