12/25/2023 0 Comments Supracondylar fracture xray![]() ![]() A gap at the fracture side after reduction should alert to possible nerve or vessel entrapment. found that in case of irreducible fractures, nerve palsy is an indication for exploration. reported isolated nerve injuries to often recover spontaneously, however in case of co-existing ischemia they recommend a surgical exploration. The median nerve is most often entrapped in the fracture. If pinned medially, the ulnar nerve is at risk for iatrogenic damage - the median nerve is at risk if pinning is performed laterally. The ulnar nerve is most often compromised in flexion-type fractures. found the anterior interosseous nerve to be at highest risk in extension-type fractures. The relative incidence of nerve injuries after supracondylar humerus fractures is reported with 12–20% due to traumatic tenting or entrapment and with 2–6.5% iatrogenic lesions during closed reposition or percutaneous pinning. Still, in 7 of 10 patients they found an ectatic lesion of the saphenous vein graft. showed in a 14-year follow-up, that surgical reconstruction of the brachial artery is an effective therapy in regard of blood supply and growth. ![]() The indication of surgical exploration and especially the appropriate timing of operation is well discussed in the literature, ,. Even after reduction of the fracture, in up to 47% of the patients with initially vascular compromise, the hand remains pulseless but perfused due to entrapment of the brachial artery within the fracture side. Growth-retardation can be result of conservative therapy of vascular trauma. Vascular compromise can be caused by arterial rupture, kinking, compression, spasm or intimal lesion and incidence increases depending on the degree of dislocation. ![]() The motion of the right hand is presented in the video ( Video 1).Ībout 8–10% of children with supracondylar fracture of the humerus have an associated injury of the brachial artery, 2.6% of the children present with a pulseless hand. The follow up after 6 months showed further clinical improvement with only minimal impairment of the median nerve in NCV analysis. Follow-up 3 months after discharge showed a range of motion of the elbow of 0/0/130° (extension/flexion), normal fist-closure and a persisting hypoesthesia of the index finger. The infection was successfully managed by antibiotic therapy. The K-wires were removed 4 weeks after the initial osteosynthesis after radiological conformation of consolidation. After neurolysis of the median nerve the continuity could be preserved. The vessels were released and after a failed Fogarty-maneuver in the artery a reversed saphenous vein graft was implemented. Intraoperative Doppler-sonography confirmed these findings. Also, the brachial vein and artery appeared attached to the fracture gap with an arterial occlusion due to a long-distance intimal lesion. In further open revision, a kinking of the median nerve, caused by scarred adhesions, could be found. Another 10 days later pain exacerbated and impaired function of the median nerve was found. Surgical revision revealed radial fluid retention - Staphylococcus aureus could be isolated microbiologically and the patient was started on antibiotics. Furthermore, we want to emphasize the good chance of an excellent outcome even after delayed revision.Ī: initial X-ray after trauma b, c: postoperative X-ray in 2 planes after revision operation. The aim of this article is to point out the importance of a neurovascular examination in pre- and postoperative course to prevent missing neurovascular injuries. We report two cases of neurological and vascular complications in terms of rupture, respectively occlusion of the brachial artery and injury of the median, respectively median and ulnar nerve after closed reduction and K-wire fixation. Especially the brachial artery and the median nerve are at risk due to stretch forces or entrapment. The incidence of vascular complications associated with supracondylar fractures ranges from 3.2 to 14.3%, nerve injuries are reported with a relative incidence of 12–20%. Ĭomplications following these fractures are infection, loss of reduction, non-union, cubitus varus or valgus and neurovascular lesions. Primary treatment of dislocated fractures is closed reduction and percutaneous pinning with Kirschner-wires ( K-wires). The mechanism leading to this fracture is most often a fall on the hand with fully extended elbow. Supracondylar humerus fractures are a common injury in children and account for approximately 15% of all pediatric fractures. ![]()
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