Management von Nervenschadigungen und Durchblutungsstrun-gen bei suprakondylaren Humerusfrakturen im Kindesalter

Dislocated supracondylar humerus fractures are frequently accompanied by neurovascular damage. Traumatic nerve damage and reduced blood supply are normally remitted by reposition and fracture stabilization. Traumatic nerve injuries are generally caused by elongation, i.e., neuropraxia, with a good prospect of spontaneous remission. The absence of expected improvement hints at a possible nerve entrapment or dissection. They require swift operative treatment in order to avoid severe sequelae. Postoperative iatrogenic nerve injuries usually concern the ulnar nerve and should be released to diminish time of reduced hand usability. A poorly perfused pulseless hand must be operated, while a pink pulseless hand should be. If the ischemia is caused by a spasm of the brachial artery, opening and taking out the he-matoma help to relax the artery. In case of entrapped tethered arterial tissue, its release is required. In delayed revascularization, the compartment should also be opened. Compartment syndrome can be caused by arterial closure, hemorrhage, or both. On first indication, a complete compartment release must be undertaken in order to avoid a rare but disastrous Volkmann contracture. Prerequisites for the necessary therapeutic decisions are a thorough clinical examination, scheduled controls, and the knowledge of typical accompanying injuries.