Ito Rina, Tokutake Katsuhiro, Takegami Yasuhiko, Okui Nobuyuki, Natsume Tadahiro, Koh Shukuki, Tatebe Masahiro, Yamamoto Michiro
Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Human Enhancement and Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Bone Jt Open. 2025 Jun 1;6(6):609-617. doi: 10.1302/2633-1462.66.BJO-2025-0020.R1.
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.
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.
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.
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.
本研究旨在确定与儿童Gartland III型肱骨髁上骨折（SCHF）相关的完全性运动麻痹的发生率、预后和结局，并确定何时需要进行一期神经探查。
在这项多中心回顾性研究中，我们调查了与儿童Gartland III型SCHF相关的完全性运动麻痹。排除医源性麻痹。使用X线片确定筋膜穿透征。记录神经探查的结果。显著病例定义为具有以下神经情况的病例：1）完全或部分撕裂；2）束缚/卡压；3）神经瘤形成；或4）在骨折部位或骨痂处卡压。记录使用超声的频率并检查其结果。
在691例Gartland III型SCHF患者中，45例（7%）出现完全性运动麻痹。其中，20例（44%）未进行一期神经探查。总体而言，18例（90%）自发恢复，2例（10%）在二期探查时需要进行神经缝合和神经移植。在其他25例（56%）进行一期神经探查的患者中，1例桡神经完全撕裂，5例神经被束缚/卡压。8例显著病例（18%）的筋膜穿透征均为阳性，这一比例显著高于其他病例（37例中的19例；p = 0.014，敏感性100%，特异性49%）。14例（31%）患者术前使用超声检查神经状况、与近端骨折块的可能接触情况以及牵引后的变化。
对于伴有完全性运动麻痹的儿童Gartland III型SCHF患者，我们估计超过10%的患者因神经被束缚/卡压或撕裂而需要进行一期神经探查。X线片上阳性的筋膜穿透征为一期神经探查提供了早期证据。此外，全身麻醉下术前超声评估神经状况可发挥关键作用。
