Early Fracture Alignment Correction and Its Association with Neurologic Recovery in Pediatric Supracondylar Humeral Fractures.

Abstract

Backgroud: Peripheral nerve injuries are a common complication of pediatric supracondylar humeral fractures. While most resolve spontaneously, the timeline for recovery remains unpredictable. This study investigated whether earlier correction of fracture alignment-regardless of timing of definitive surgical fixation-shortens the duration of neurologic recovery.

Methods: We retrospectively reviewed pediatric patients (< 18 years) treated surgically for supracondylar humeral fractures between October 2008 and February 2025. Patients presenting with preoperative neurologic deficits were included. Timing of fracture alignment correction (via manipulation or surgery) and surgical fixation were recorded from the reported time of injury. The primary outcome was time to complete neurologic recovery, defined as full return of motor and/or sensory function. Statistical analyses included Pearson correlation, Mann-Whitney U-test at clinical time thresholds, and multivariate linear regression.

Results: Among 341 cases, 35 patients (10.3%) presented with neurologic deficits, and 31 were included in the final analysis. Sensory deficits recovered significantly faster than motor or mixed-type injuries (mean, 13.4 vs. 91.4 days, p = 0.002). Among time-related variables, alignment correction within 4 hours of injury was significantly associated with faster neurologic recovery (23.9 vs. 93.5 days, p = 0.010), while surgical timing had no significant effect. This association remained marginally significant in multivariate analysis adjusting for injury type, nerve involvement, and fracture classification (p = 0.065).

Conclusions: Early fracture alignment correction-especially within 4 hours-showed a trend toward faster neurologic recovery. This finding suggests that time-sensitive decompression may play an important role in promoting favorable neurologic recovery in pediatric supracondylar humeral fractures.