## Nerve Injuries in Supracondylar Fractures **Key Point:** The radial nerve is the most commonly injured nerve in supracondylar fractures, NOT the anterior interosseous nerve (AIN). ### Frequency of Nerve Injuries | Nerve | Frequency | Mechanism | |-------|-----------|----------| | **Radial nerve** | 10–15% (most common) | Injury from fracture fragments or traction | | **Median nerve** | 5–10% | Often iatrogenic during pinning | | **Anterior interosseous nerve (AIN)** | 1–2% (least common) | Rare, often associated with median nerve injury | | **Ulnar nerve** | 5–8% | Can occur with medial displacement | **High-Yield:** Radial nerve injury typically presents with wrist drop and loss of thumb extension. Most nerve injuries recover spontaneously within 3–6 months. ### Other True Statements **Volkmann's Contracture:** - Late complication arising from acute compartment syndrome - Results from muscle necrosis and fibrosis in the forearm - Prevention is key: early recognition and fasciotomy if compartment syndrome develops **Treatment:** - Closed reduction with percutaneous pinning (CRPP) is the gold standard for displaced (Gartland Type II–III) fractures - Allows early mobilization and reduces stiffness **Brachial Artery Injury:** - Occurs in 5–10% of supracondylar fractures - Often resolves with reduction alone; vascular repair rarely needed - Absence of radial pulse post-reduction does not always mandate exploration if perfusion is adequate **Clinical Pearl:** Always perform a thorough neurovascular examination before and after reduction. Document findings carefully, as some nerve injuries are pre-reduction (from trauma) and others are post-reduction (from manipulation or pinning).
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