Feasibility of Pre-Operative Neurovascular Examination in Pediatric Elbow Fractures

Abstract

A detailed pre‐operative examination of a child’s neurovascular status following pediatric elbow fractures is critical to the assessment of these injuries. Without proper documentation of the preoperative exam, apparent postoperative changes in the neurovascular examination may be difficult to determine, and may dictate different treatment strategies. The reported incidence of neurologic (11.3%) and vascular (0.3‐4.6%) injury associated with supracondylar fractures underscores the importance of the preoperative exam. The purpose of this prospective study was to determine how frequently a complete neurovascular exam could be completed in children with elbow fractures. A detailed, specific elbow fracture History and Physical form was developed for prospective use on all pediatric elbow fractures in a tertiary care pediatric trauma hospital from 2013 through 2014. Specific neurovascular exam criteria were documented in an easily used checklist form. Demographic data collected included age, BMI, mechanism of injury, fracture type, comorbidities, pre‐operative pain management, and the operative procedure performed. There were 163 patients meeting the inclusion criteria. Attempted neurovascular (NV) exam was documented in 146 of these patients (89.6%). A clinically reliable, complete NV exam was possible in 104 patients (71.2%). In the remainder of the children, the clinician could not determine at least one aspect of the neurovascular exam. A significant correlation was found between age of the subject and ability to obtain a complete exam, with younger children less than age 5 being more likely to have incomplete information on the NV exam (p<0.000001). Gender, BMI, fracture type, pre‐assessment pain control, and potential language barriers had no effect on whether or not the exam was complete. Although a complete and detailed neurovascular examination is considered necessary when evaluating pediatric elbow fractures, over a fourth of our patients (29%) were unable to reliably participate in a full preoperative neurovascular exam. Younger children (less than 5 years of age) were less likely to participate in a complete neurovascular assessment. Neurovascular examinations in the setting of elbow fractures in children less than five years of age were unreliable and incomplete.