Critical displacement of neural injuries in supracondylar humeral fractures in children

To investigate a relation between the degree of initial fracture displaceme nt and nerve complication, 53 consecutive acute extension-type supracondyla r humeral fractures in children during 10 years were analyzed. From the ini tial roentgenographs, the direction and degree of displacement of each frac ture were plotted on the coronal two-dimensional coordinates at the fractur e site. The degree of displacement was represented by a diameter of the hum eral shaft. Of 53 fractures, 42 were displaced. Six patients had nerve inju ries, representing an 11.3% incidence of neurologic complication. Their dis placements were >90% of the diameter of the shaft. Predictive negative and positive displacements of the median nerve were <90% of the diameter and >1 50% of that in posterolaterally displaced fractures, respectively. Those of radial nerve were <130% and >190% in posteromedially displaced fractures, respectively.