Nerve Injury Severity and Outcomes: An Analysis of Supracondylar Humeral Fractures.

BACKGROUND

Nerve injuries (NI) after pediatric supracondylar humeral fractures (SHF) are commonly reported as neurapraxic, with most studies focusing on motor recovery alone. This study aimed to analyze both sensory and motor outcomes of NI in SHF to identify patterns of recovery and predictors of prolonged nerve recovery.

METHODS

A 4-year retrospective cohort study of children 0 to 12 years with NI after SHF was performed. Patterns of nerve recovery and outcomes of spontaneous recovery were analyzed descriptively. Predictors of prolonged nerve recovery (>4 months) were explored using multivariable logistic regression.

RESULTS

Of 1,137 children with SHF, 93 (52% male; mean age 7.2 ± 2.1 years) presented with traumatic NI. The median nerve was most frequently injured (62.4%, n = 58), followed by the radial (29.0%, n = 27) and ulnar nerves (8.6%, n = 8). All children had both sensory and motor deficits; there were no motor-only injuries. Complete spontaneous recovery occurred in 90 children, with 64% (n = 56) taking more than 4 months to recover. Two patients (2.2%) had neurotmetic injuries necessitating nerve grafting. Radial NI showed faster recovery, with 69.2% (n = 18) resolving within 4 months, compared with 20.6% (n = 12) and 25% (n = 2) of median and ulnar NI, respectively.

CONCLUSIONS

Traumatic NI after pediatric SHF achieve full spontaneous recovery in most cases, but the majority take longer than 4 months to recover. Radial NI recover more rapidly (<4 months) than median or ulnar NI. Factors such as time to surgery, presence of a pink-pulseless limb, and multidirectional instability did not predict prolonged recovery in extension-type SHF.

LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.