O3265: Faster Time to Surgery Reduces Nerve Recovery Time in Pediatric Supracondylar Humerus Fractures

Background: Nerve injuries in pediatric supracondylar humerus fractures (SCH) occur in up to 16% of patients. Evidence exists of isolated anterior interosseous nerve injuries (AIN) not being influenced by time to surgery, however, little is known about other nerve injuries. This study aimed to use a large cohort of patients with traumatic nerve injuries associated with SCH fractures to examine the impact of time to surgery on nerve recovery.

Methods: Patients < 18 years old who were stabilized using percutaneous pins for SCH fractures from January 2009 to June 2022 were retrospectively reviewed. Patients presenting with any traumatic nerve injury with complete post-operative recovery were included while those with iatrogenic/postoperative nerve injuries and incomplete documentation of nerve recovery were excluded. Demographic data, injury characteristics, time from injury to surgery, and days to complete neurological recovery were collected. Comparisons of nerve recovery time were made by anatomic distribution and functional deficit using ≤8 hours from injury (early) versus >8 hours from injury (late) using bivariate statistical analysis.

Results: A total of 2753 SCH fractures were identified with 214 traumatic nerve injuries. Documentation of complete nerve resolution was available in 180 patients with an overall mean age of 6.85 ± 2.17 years. Time to recovery in the multiple anatomic nerve distributions was similar (p=0.794) while significantly different among the different functional deficit cohorts (p < 0.001). Overall fractures surgically treated earlier than 8 hours had a faster nerve recovery than those treated after 8 hours (p < 0.001). Isolated single nerve injuries, isolated motor deficits, and isolated sensory deficits showed no significant difference in nerve recovery when surgically treated early (p>0.05) while patients with multiple nerve distributions (p=0.024) and mixed motor and sensory deficits (p < 0.001) treated early had a faster nerve recovery compared to those treated late.

Conclusion: Surgical timing impacts the time to recovery of complex nerve injuries. Early surgical management of patients with multiple nerve injuries and/or mixed motor-sensory deficits may help reduce the time to complete nerve recovery.