Prevalence of Nerve Injuries in Supracondylar Fracture of Humerus in a Tertiary Care Hospital.

BACKGROUND: Supracondylar fracture is a common childhood injury. These fractures are often associated with neural and vascular injuries. There is discrepancy in literature about the most common nerve injured in such fractures. This study aims to study the nerve injury patterns in supracondylar fractures of humerus in Nepalese children. METHODS: This descriptive cross sectional study was conducted in 152 children (aged 2 to 14 years) with supracondylar fractures of humerus attending in Bharatpur Hospital during the period of one year. All eligible patients were assessed clinically and radiologically. Neurological assessment was done for nerve injury. RESULTS: Out of 152 children, 18(11.8%) had nerve injuries. The mean age was 7.41±2.91 years. Boys were more injured (68.4%) than girls (31.6%). It was more common on non-dominant side (57.9%). Out of 18 nerve injuries, most commonly injured nerve was median nerve 10(55.5%) followed by radial nerve 7(38.9%). Median nerve injury was common in posterolateral displacement and radial nerve injury was common in posteromedial displacement type of fracture.   Conclusions: Displaced supracondylar fractures have relatively higher prevalence of nerve injuries. Most commonly involved nerve is median nerve followed by radial nerve. So, every displaced fracture should be routinely screened for nerve injuries.

Epidemiology of Femur Fractures in Children: A Descriptive Cross Sectional Study Based on a Rural Population of Nepal.

INTRODUCTION: Femur fracture in children is one of the most common lower limb fractures which require inpatient care. The aim of this study is to determine the epidemiology of femoral shaft fractures in children from a rural population of Karnali Nepal. METHODS: Hospital records were retrospectively reviewed from May 2017 to April 2020 to identify all the children with femur fracture. Sociodemographic profile, mode of injury, fracture pattern and location, time of presentation, initial treatment by traditional bone setters, treatment method and duration of hospital stay were noted. Data analysis was done using Statistical Package for Social Sciences version 20. RESULTS: Altogether 104 children were identified. The mean age was 5.55 years and boys predominated 65 (62.5%). Falls were the major mode of injury in 65 (62.4%) patients. Fractures were frequently noted between April 15 to August 15. There were four (3.8%) open fractures and concurrent fracture observed in eight (7.6%) patients. Ten (9.6%) children received prior treatment from traditional bonesetters. Treatment methods included hip spica 62 (59.6%), elastic intramedullary nailing 30 (28.8%) and plate fixation 12 (11.5%). The duration of hospital stay in the nailing and plate fixation group was 11.43 days and 18 days respectively. CONCLUSIONS: Fracture was common in 2-6 years of age group in boys during summer. Fall from cliff, rooftop and ladder were the major preventable cause of fracture. Delayed presentation and prior treatment with traditional bone setters add special challenges to orthopedic surgeons working in rural teaching hospital.