Rock-Paper-Scissors-OK in Nerve Examination

Patients presenting to the Orthopedics and Traumatology Clinic of Ankara Bilkent City Hospital with supracondylar humerus (elbow) fractures will initially undergo closed reduction. Following the reduction procedure, radiographic imaging will be obtained and patients will be re-evaluated. If surgical intervention is deemed necessary based on this assessment, operative treatment will be recommended.

The surgical technique will consist of closed reduction followed by percutaneous Kirschner wire (K-wire) fixation. In cases where adequate fracture reduction cannot be achieved by closed means, open reduction will be performed through an anterior incision. In these patients, K-wires will again be inserted percutaneously.

Fixation will be achieved using one medial (ulnar side) and two lateral K-wires. Postoperatively, a neurological examination will be performed. In patients who are shown a video and taught the game beforehand, neurological assessment will be conducted using the "rock-paper-scissors" game. In other patients, the examination will be performed by demonstrating and requesting specific hand movements.

If ulnar nerve deficit is detected during postoperative neurological evaluation, the medial K-wire will be removed. The time interval between the patient's emergence from anesthesia and the neurological examination will be recorded.