Meta-analysis of 55 studies and 5,148 pediatric patients with displaced supracondylar humeral fractures, examining which nerves are most at risk from the fracture itself (traumatic neurapraxia) and from percutaneous pinning (iatrogenic neurapraxia), stratified by fracture type and pin configuration.
When you see a displaced extension-type supracondylar fracture, specifically test AIN function (thumb and index finger pinch — "OK sign") because it is the most commonly injured nerve and is easily missed in a painful child.
When choosing pin configuration, know that medial pins put the ulnar nerve at significant risk (OR 8.77), but lateral-only pinning is not risk-free. It carries a nearly 4× increased risk of median nerve injury that should be included in your consent discussion.
Meta-analysis of 55 studies and 5,148 pediatric patients with displaced supracondylar humeral fractures, examining which nerves are most at risk from the fracture itself (traumatic neurapraxia) and from percutaneous pinning (iatrogenic neurapraxia), stratified by fracture type and pin configuration.
When you see a displaced extension-type supracondylar fracture, specifically test AIN function (thumb and index finger pinch — "OK sign") because it is the most commonly injured nerve and is easily missed in a painful child.
When choosing pin configuration, know that medial pins put the ulnar nerve at significant risk (OR 8.77), but lateral-only pinning is not risk-free. It carries a nearly 4× increased risk of median nerve injury that should be included in your consent discussion.