Supracondylar fracture of the humerus occasionally accompanies nerve palsy in children. This report discusses treatment of this fracture with reference to treatment of patients with combined nerve palsy.
Nerve palsy was found in 5 of 34 patients (14.7%). The type of fracture, reduction maneuver and time course of palsy were examined in the 5 patients. According to Abe's classification, 1 was type I, 2 type II and 2, type III. The more severe the fracture, the more frequent was the nerve palsy. All 5 patients showed nerve palsy on their first visit to the hospital. In 4 patients, the palsy improved following anatomical reduction. One patient, with a type II fracture, did not improve after reduction, and 3 months later, the lacerated radial nerve was reconstructed surgically. This nerve may be injured by a fracture fragment at the time of the accident, furthermore during reduction this nerve may be impinged by proximal and distal fragments. Reduction in this case was mainly conducted by flexion force, since the fracture was a simple extension type. In comparison, in the 4 other patients the reduction force was produced not only by flexion but by traction as well, since their fractures were types III or IV. The nerve in the vicinity of the fracture site was separated from the site by traction, thus preventing impingement of the nerve.
In conclusion, patients with nerve palsy may require reduciton to adequately tract the distal fragment first so as to prevent nerve impingement.
