Between 1998 and 2002, 37 neuropathies in 32 patients with a displaced supracondylar fracture of the humerus who were referred to a nerve injury unit were identified. There were 19 boys and 13 girls with a mean age of 7.9 years (3.6 to 11.3). A retrospective review of these injuries was performed. The ulnar nerve was injured in 19, the median nerve in ten and the radial nerve in eight cases. Fourteen neuropathies were noted at the initial presentation and 23 were diagnosed after treatment of the fracture. After referral, exploration of the nerve was planned for 13 patients. Surgery was later cancelled in three because of clinical recovery. Six patients underwent neurolysis alone. Excision of neuroma and nerve grafting were performed in four. At follow-up, 26 patients had an excellent, five a good and one a fair outcome.

Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children: the experience of a specialist referral centre.

Radial tunnel syndrome.

Although acute vascular injury is a common complication in children with severely displaced supracondylar humeral fractures, the management of patients with a pink pulseless hand still remains controversial Between 1994 and 2006, 66 children with displaced supracondylar fractures of the humerus were treated Five patients had an absence of the radial pulse with an otherwise well perfused hand In one patient, radial pulse returned after closed reduction of the fracture In four patients, open reduction and vascular exploration was required Three patients had brachial artery occlusion because of thrombus formation Thrombectomy was performed, which led to the restoration of a palpable radial pulse In one patient with open fracture, brachial artery contusion and spasm were found, and treated by removal of adventitia Surgical exploration for the restoration of brachial artery patency should be performed, even in the presence of viable pink hand after an attempt at closed reduction

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Treatment of pink pulseless hand following supracondylar fractures of the humerus in children.

Peripheral compression neuropathy is a common clinical entity but little human nerve material has been available for study. It has been difficult to develop an experimental model of chronic nerve compression which is reliable and reproducible, making it difficult to assess the various treatment modalities currently in use to manage this problem. In a recent study using a rat model, connective tissue and nerve fiber changes associated with chronic nerve compression were described by the authors. The present study expands this same model of chronic nerve compression to the multifascicular median nerve of the cynomolgus monkey, using this model to test whether or not current surgical treatment modalities for nerve entrapment will alter the course of chronic nerve compression. Using histologic and morphometric parameters, there did not appear to be a difference between nerves treated by decompression alone or by decompression and internal neurolysis. Total number of nerve fibers remained constant, as did axon size, but a demyelinating process was demonstrated which is a significant component of chronic nerve compression. Although the small number of experimental animals (7) makes precise evaluation of the clinical modalities impossible, the authors expect that further study of the multifascicular median nerve of the cynomolgus monkey will prove to be a useful source of future experimental evidence and will help to interpret the diverse therapeutic and operative techniques currently in use.

A primate model for chronic nerve compression

The management of children's fractures has evolved as a result of better health education, changes in lifestyle, improved implant technology and the changing expectations of society. This review focuses on the changes seen in paediatric fractures, including epidemiology, the increasing problems of obesity, the mechanisms of injury, non-accidental injuries and litigation. We also examine the changes in the management of fractures at three specific sites: the supracondylar humerus, femoral shaft and forearm. There has been an increasing trend towards surgical stabilisation of these fractures. The reasons for this are multifactorial, including societal expectations of a perfect result and reduced hospital stay. Reduced hospital stay is beneficial to the social, educational and psychological needs of the child and beneficial to society as a whole, due to reduced costs.

Changing trends in the management of children’s fractures

The cases of forty patients who were operated on consecutively for palsy of the posterior interosseous nerve were analyzed. The injury was iatrogenic in sixteen patients, traumatic in fifteen, and nontraumatic in nine. Persistent paralysis (partial or cornplete) was the only indication for operation. Operative neurolysis was done in twenty-three patients; interfascicular nerve-grafting, in twelve; internal neurolysis, in one; and tendon transfer, in four. An excellent or good functional result was documented for all but three patients, of whom two had had neurolysis and one, nerve-

http://synapse.koreamed.org/Synapse/Data/PDFData/1104JKSF/jksf-4-369.pdf

Yeu Seung Yoon

Papers

Neural injuries associated with supracondylar fractures of the humerus in children