Rock-paper-scissors-OK game for neurological examination in pediatric supracondylar humerus fractures: A prospective randomized controlled trial.

Abstract

Purpose: Pediatric supracondylar humerus fractures frequently involve nerve injuries, which can be difficult to assess before and after surgery. This study evaluated a smartphone application that teaches nerve examination to children using a rock-paper-scissors-OK game, and assessed its effects on examination time and satisfaction.

Methods: In this single-center, prospective randomized controlled study, 102 children aged 4-10 years who underwent surgical treatment were randomized into 2 groups. Group 1 learned nerve examination through the classical method taught by orthopedic residents and a specialist. Group 2 was taught using the smartphone application with the game. Pre- and postoperative nerve examination times were recorded. Child and parent satisfaction were measured with the Child HCAHPS questionnaire.

Results: Mean preoperative examination time was shorter in group 1 (4.3 ± 1.3 min) (p = 0.036), while postoperative time was shorter in group 2 (12.2 ± 2.4 min; p = 0.041). Although the app-based method took longer preoperatively, children in group 2 adapted better, enabling faster postoperative assessments. Agitation, crying, and noncompliance were less frequent in the game-assisted group. Satisfaction scores were higher in group 2 for "Communication with Doctors" (p = 0.032) and "Keeping You Informed" (p = 0.041), with no differences in other domains. Temporary nerve deficits occurred at similar rates and resolved spontaneously in all cases.

Conclusions: A smartphone-based rock-paper-scissors-OK game improves postoperative nerve examination efficiency and increases satisfaction, particularly regarding communication and information sharing.

Level of evidence: Level II.

Trial registration: ClinicalTrials.gov identifier NCT07480798; retrospectively registered on 16 March 2026, after study initiation on 13 March 2024(Supplemental Material 1).