Humeral supracondylar fracture commonly results in which nerve injury: September 2007

Ans. D: Median Nerve Supracondylar humerus fracture: Most common < 10 years, peak age 5-8 years Constitutes 80% of all pediatric distal humerus fractures 2:1 males to female ratio Classificatio: Extension type: Extension type accounts for 90-98% of all supracondylar fractures Flexion type Galand Classification is commonly used to classify extension type of injuries: I: Nondisplaced IIA: displaced, posterior coex intact; rotationally stable, intact posterior coex acts like a hinge IIB: displaced, posterior coex intact; rotationally unstable III: completely displaced, no coical contact, most often a medial periosteal sleeve intact when medially displaced and vice-versa Management: i. Closed Reduction is done for type I and type II fractures. Closed reduction is not attempted in type III fractures. Assessing adequacy of reduction: Jones view: hyperflexion shoot through elbow Baumann's Angle: comparison to uninjured side, difference of more than 5degrees is unacceptable Anterior Humeral Line Type III fracture: Increased swelling and soft tissue injury Proper neurovascular and compament assessment Closed reduction and percutaneous pinning is the management of choice, 2 pins may achieve stability Neurologic Injury: 5-19% of supracondylar farctures More in type III supracondylar fractures Median nerve 52% (especially posteromedial displacement) Radial nerve: 28% Most are neuropraxic injuries Motor Recovery may take 7-12 weeks Sensory recovery may take nearly 6 months