Supracondylar humeral fractures with isolated anterior interosseous nerve injuries: is urgent treatment necessary?
BACKGROUND
It is unclear if pediatric patients with a supracondylar humeral fracture and isolated anterior interossous nerve injury require urgent treatment.


METHODS
A retrospective, multicenter study of 4409 patients with operatively treated supracondylar humeral fractures was conducted. Exclusion criteria were additional nerve injuries other than the anterior interosseous nerve, any sensory changes, pulselessness, ipsilateral forearm fractures, open fractures, less than two months of follow-up, or pathological fractures.


RESULTS
Thirty-five of 4409 patients met inclusion criteria. The average time to surgery was 14.6 hours (range, two to thirty-six hours). No patient developed compartment syndrome. There was no significant difference in time to return of anterior interosseous nerve function relative to the time to surgical reduction and fixation (p = 0.668). A complete return of anterior interosseous nerve function occurred in all patients with an average time of forty-nine days (range, two to 224 days). Ninety percent of patients recovered anterior interosseous nerve function by 149 days.


CONCLUSIONS
To our knowledge, this is the largest series to date of supracondylar humeral fractures with anterior interosseous nerve injuries. There is no evidence that a supracondylar humeral fracture with an isolated anterior interosseous nerve injury requires urgent treatment. A delay in treatment up to twenty-four hours was not associated with an increased time of nerve recovery or other complications. This series excluded patients with sensory nerve injuries, pulselessness, and ipsilateral forearm fractures, which all may require urgent surgery. Barring other clinical indications for urgent treatment of a supracondylar humeral fracture, an isolated anterior interosseous nerve injury (no sensory changes) may not by itself be an indication for urgent surgery. The anterior interosseous nerve injuries in this series showed complete recovery at a mean time of forty-nine days.
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS#69, Los Angeles, CA 90027. E-mail address for D.L. Skaggs: dskaggs@chla.usc.edu.
Kody K
KK
Barrett
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS#69, Los Angeles, CA 90027. E-mail address for D.L. Skaggs: dskaggs@chla.usc.edu.
David L
DL
Skaggs
Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 520, Memphis, TN 38104.
Jeffrey R
JR
Sawyer
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS#69, Los Angeles, CA 90027. E-mail address for D.L. Skaggs: dskaggs@chla.usc.edu.
Lindsay
L
Andras
Le Bonheur Children's Hospital, 50 North Dunlap Street, Memphis, TN 38103.
Alice
A
Moisan
Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104.
Christine
C
Goodbody
Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104.
John M
JM
Flynn
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000150:complications* / Q000601:surgery*; D007223:Infant; D008297:Male; D059348:Peripheral Nerve Injuries / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors