The assessment of peripheral nerves in children with upper limb injuries can be challenging.
Neurovascular deficit was not documented in 25% of children presenting with upper extremity injury
BOAST (British Orthopedic Association Standards for Trauma) guidelines state that each of the Median, Ulnar, Radial, Anterior Interosseous Nerve exams must be individually documented in any supracondylar fracture
Dawson described an easy way to test and document your exam. Have the child play “Rock, Paper, Scissors, Ok”
Rock: tests the Median nerve
Paper: tests the Radial nerve
Scissors: tests the Ulnar nerve
Ok: tests the Anterior Interosseous nerve
This method increased proper documentation and reduced missed nerve injuries in upper extremity fractures.
Dr. Sarah Edwards and Dr. Hannah Lock created an easy infographic in the link below and found near 100% increase in NV documentation in their ED. Their poster won the prize for best infographic at the 2018 Emergency Medicine Educators' Conference (EMEC)
Marsh AG, Robertson JS, Goodman A, Boyle J, Huntly JS. Introduction of a simple guideline to improve neurological assessment of paediatric patients presenting with upper limb fractures. Emerg Med J. 2016 Apr;(33)4:273-7