NEUROVASCULAR INJURY AND DISPLACEMENT IN TYPE-III SUPRACONDYLAR HUMERUS FRACTURES

From July 1987 to January 1998, 59 consecutive type III supracondylar humerus fractures in children were identified at Children's Hospital, Boston. Twenty-nine patients (49%) had evidence of neurovascular compr omise. The median nerve was involved in 15 (52%) of these patients and was associated with posterolateral displacement in 87% of cases. The radial nerve was involved in eight (28%) of these patients and was ass ociated with posteromedial displacement in every case. Injuries to the brachial artery occurred in 11 (38%) of these patients and was associ ated with posterolateral displacement in 64% and posteromedial displac ement in 36% of cases. We conclude that posterolateral displacement in type III supracondylar humerus fractures is strongly associated with median nerve injuries. Posteromedial displacement is responsible for i njuries to the radial nerve in virtually every instance. Brachial arte ry injuries may occur with either type of displacement. Neurovascular injury is higher than previously reported in these fractures.