Journal of Children's Orthopaedics - 2026-07-10 - Journal Article
Rock-paper-scissors-OK game for neurological examination in pediatric supracondylar humerus fractures: A prospective randomized controlled trial.
Aydin T, Inci F, Kilic M, Yigit N, Kahve Y, Ceyhan E
Topics
Key Takeaway
A smartphone game-based nerve examination protocol reduced postoperative neurological assessment time to 12.2 ± 2.4 minutes versus a longer classical-method time in pediatric supracondylar humerus fractures (n=102).
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Summary
This single-center RCT randomized 102 children aged 4–10 years undergoing surgical fixation for supracondylar humerus fractures to classical resident-taught nerve examination versus a smartphone rock-paper-scissors-OK game-based protocol. Preoperative examination was faster with the classical method (4.3 ± 1.3 min, p=0.036), but postoperative examination was faster in the game group (12.2 ± 2.4 min, p=0.041), with less agitation and noncompliance. Child HCAHPS satisfaction scores were higher in the game group for 'Communication with Doctors' (p=0.032) and 'Keeping You Informed' (p=0.041).
Key Limitation
Retrospective trial registration after study initiation renders the RCT designation unreliable and raises serious concern for selective outcome reporting.
Original 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).