Long-term Functional Results of Neurological Complications of Pediatric Humeral Supracondylar Fractures.
OBJECTIVE
It has been reported that most neurological injuries after sustaining a supracondylar fracture will usually resolve spontaneously in the first months; however, studies are lacking regarding the influence of these injuries in the upper limb functionality in the long-term follow-up. The aim of this study is to report the long-term functional outcome of neurological complications associated to pediatric supracondylar fractures.


METHODS
Medical records of 448 children who sustained a supracondylar humeral fracture were reviewed. Patients with a concomitant neurological injury were included. Clinical evaluation included grip and pinch strength and a thorough examination of sensibility. Clinical outcomes were described according to the Mayo Elbow Performance Score and Flynn criteria. Patients completed the quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) questionnaire.


RESULTS
There were 29 patients with a supracondylar humeral fracture and a neurological injury (6.5%). The median nerve was injured in 13 patients, the radial nerve in 14 patients and the ulnar nerve in 9 patients. Of them, 16 patients returned for clinical evaluation. The mean age at the time of fracture was 7.5±1.9 years and at revision 16±5.3 years. The average follow-up was 8.6±4.8 years (3.4 to 17.4 y). There were no differences in terms of grip or pinch strength. Seven patients referred paresthesias, 6 of them in the ulnar nerve's territory. The average score was 4±3 (median, 4) for the QuickDASH questionnaire and 96±7 for the Mayo Elbow Performance Score. According to Flynn criteria, results were satisfactory in 10 cases.


CONCLUSIONS
Functional results were excellent in the majority of patients. Almost half of the patients referred paresthesias, mostly in the ulnar nerve territory, that were not limiting normal daily activity. At final follow-up, although 100% of the radial nerve injuries and 87.5% of the median nerve injuries were fully recovered, only 25% of the ulnar nerve injuries were.


METHODS
Level IV-prognostic study.
*Department of Orthopedics Surgery, Hospital Universitario Ramon y Cajal Departments of †Orthopedics Surgery ‡Clinical Epidemiology & Biostatistics, Hospital Universitario La Paz, Madrid, Spain.
Maria
M
Valencia
Luis
L
Moraleda
Jesús
J
Díez-Sebastián
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000150:complications* / Q000601:surgery; D007223:Infant; D008297:Male; D008475:Median Nerve / Q000293:injuries*; D010292:Paresthesia / Q000209:etiology*; D052581:Pinch Strength / Q000502:physiology*; D011826:Radial Nerve / Q000293:injuries*; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014459:Ulnar Nerve / Q000293:injuries*; D055815:Young Adult