Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures: a multicentre retrospective study
Aims: This study aims to determine the prevalence, prognosis, and outcome of complete motor paralysis associated with Gartland type III paediatric supracondylar humerus fractures (SCHFs) and identify when primary nerve exploration is indicated. Methods: In this multicentre retrospective study, we...
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The British Editorial Society of Bone & Joint Surgery
2025-06-01
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| Series: | Bone & Joint Open |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.66.BJO-2025-0020.R1 |
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| author | Rina Ito Katsuhiro Tokutake Yasuhiko Takegami Nobuyuki Okui Tadahiro Natsume Shukuki Koh Masahiro Tatebe Michiro Yamamoto |
| author_facet | Rina Ito Katsuhiro Tokutake Yasuhiko Takegami Nobuyuki Okui Tadahiro Natsume Shukuki Koh Masahiro Tatebe Michiro Yamamoto |
| author_sort | Rina Ito |
| collection | DOAJ |
| description | Aims: This study aims to determine the prevalence, prognosis, and outcome of complete motor paralysis associated with Gartland type III paediatric supracondylar humerus fractures (SCHFs) and identify when primary nerve exploration is indicated. Methods: In this multicentre retrospective study, we investigated complete motor paralysis associated with Gartland type III paediatric SCHFs. Iatrogenic paralysis was excluded. Radiographs were used to determine a fascial penetration sign. Findings from nerve explorations were recorded. Notable cases were defined as those with the following nerve conditions: 1) complete or partial laceration; 2) tethering/entrapment; 3) formation of a neuroma; or 4) entrapment at the fracture site or callus. The frequency with which ultrasound was used was documented and its findings were examined. Results: Among 691 patients with Gartland type III SCHFs, 45 (7%) had complete motor paralysis. Of these, 20 (44%) were managed without primary nerve exploration. Overall, 18 (90%) spontaneously recovered and two (10%) required neurorrhaphy and nerve grafting during a secondary exploration. Of the other 25 (56%) who underwent primary nerve exploration, one had a complete radial nerve laceration, and five had tethered/entrapped nerves. The fascial penetration sign was positive in each of the eight notable cases (18%), a rate that was substantially higher than in the others (19 of 37; p = 0.014, sensitivity 100%, specificity 49%). Ultrasound was used preoperatively in 14 cases (31%) to investigate the condition of the nerve, possible contact with the proximal fragment, and its changes after traction. Conclusion: For Gartland type III paediatric SCHF patients with complete motor paralysis, we estimate that more than 10% require primary nerve exploration due to tethered/entrapped or lacerated nerves. A positive fascial penetration sign on radiography provided early evidence that primary nerve exploration was warranted. In addition, preoperative ultrasound under general anaesthesia to assess the condition of the nerves can play a crucial role. Cite this article: Bone Jt Open 2025;6(6):609–617. |
| format | Article |
| id | doaj-art-37396e3cec5b4c86bdf11bf1c7f5abc1 |
| institution | Kabale University |
| issn | 2633-1462 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
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| series | Bone & Joint Open |
| spelling | doaj-art-37396e3cec5b4c86bdf11bf1c7f5abc12025-08-20T03:28:17ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Open2633-14622025-06-016660961710.1302/2633-1462.66.BJO-2025-0020.R1Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures: a multicentre retrospective studyRina Ito0Katsuhiro Tokutake1Yasuhiko Takegami2Nobuyuki Okui3Tadahiro Natsume4Shukuki Koh5Masahiro Tatebe6Michiro Yamamoto7Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, JapanDepartment of Human Enhancement and Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, JapanDepartment of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, JapanDepartment of Orthopaedic Surgery, Yokkaichi Municipal Hospital, Yokkaichi, JapanDepartment of Orthopaedic Surgery, Kariya Toyota General Hospital, Kariya, JapanDepartment of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, JapanHand and Microsurgery Center, Anjo Kosei Hospital, Anjo-shi, JapanDepartment of Human Enhancement and Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, JapanAims: This study aims to determine the prevalence, prognosis, and outcome of complete motor paralysis associated with Gartland type III paediatric supracondylar humerus fractures (SCHFs) and identify when primary nerve exploration is indicated. Methods: In this multicentre retrospective study, we investigated complete motor paralysis associated with Gartland type III paediatric SCHFs. Iatrogenic paralysis was excluded. Radiographs were used to determine a fascial penetration sign. Findings from nerve explorations were recorded. Notable cases were defined as those with the following nerve conditions: 1) complete or partial laceration; 2) tethering/entrapment; 3) formation of a neuroma; or 4) entrapment at the fracture site or callus. The frequency with which ultrasound was used was documented and its findings were examined. Results: Among 691 patients with Gartland type III SCHFs, 45 (7%) had complete motor paralysis. Of these, 20 (44%) were managed without primary nerve exploration. Overall, 18 (90%) spontaneously recovered and two (10%) required neurorrhaphy and nerve grafting during a secondary exploration. Of the other 25 (56%) who underwent primary nerve exploration, one had a complete radial nerve laceration, and five had tethered/entrapped nerves. The fascial penetration sign was positive in each of the eight notable cases (18%), a rate that was substantially higher than in the others (19 of 37; p = 0.014, sensitivity 100%, specificity 49%). Ultrasound was used preoperatively in 14 cases (31%) to investigate the condition of the nerve, possible contact with the proximal fragment, and its changes after traction. Conclusion: For Gartland type III paediatric SCHF patients with complete motor paralysis, we estimate that more than 10% require primary nerve exploration due to tethered/entrapped or lacerated nerves. A positive fascial penetration sign on radiography provided early evidence that primary nerve exploration was warranted. In addition, preoperative ultrasound under general anaesthesia to assess the condition of the nerves can play a crucial role. Cite this article: Bone Jt Open 2025;6(6):609–617.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.66.BJO-2025-0020.R1paediatricssupracondylar humerus fracturesmotor nerve paralysisprimary nerve explorationultrasoundperipheral nervespaediatric supracondylar humerus fracturesnervesnerve paralysisparalysisradial nervesradiographsneuromasgeneral anaesthesiafracture sitenerve grafting |
| spellingShingle | Rina Ito Katsuhiro Tokutake Yasuhiko Takegami Nobuyuki Okui Tadahiro Natsume Shukuki Koh Masahiro Tatebe Michiro Yamamoto Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures: a multicentre retrospective study Bone & Joint Open paediatrics supracondylar humerus fractures motor nerve paralysis primary nerve exploration ultrasound peripheral nerves paediatric supracondylar humerus fractures nerves nerve paralysis paralysis radial nerves radiographs neuromas general anaesthesia fracture site nerve grafting |
| title | Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures: a multicentre retrospective study |
| title_full | Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures: a multicentre retrospective study |
| title_fullStr | Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures: a multicentre retrospective study |
| title_full_unstemmed | Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures: a multicentre retrospective study |
| title_short | Primary nerve exploration is required in more than 10% of complete motor nerve paralysis cases associated with Gartland type III paediatric supracondylar humerus fractures: a multicentre retrospective study |
| title_sort | primary nerve exploration is required in more than 10 of complete motor nerve paralysis cases associated with gartland type iii paediatric supracondylar humerus fractures a multicentre retrospective study |
| topic | paediatrics supracondylar humerus fractures motor nerve paralysis primary nerve exploration ultrasound peripheral nerves paediatric supracondylar humerus fractures nerves nerve paralysis paralysis radial nerves radiographs neuromas general anaesthesia fracture site nerve grafting |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2633-1462.66.BJO-2025-0020.R1 |
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