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Median nerve compression associated with displaced Salter-Harris type II distal radial epiphyseal fracture
P M Binfield1, A Sott-Miknas, C J Good
1Department of Orthopaedics, Newham General Hospital, Plaistow, London, UK.
Insights
Immediate manipulation under anesthesia (MUA) effectively treated median nerve compression in children with Salter-Harris Type II distal radius fractures. This approach restored nerve function without long-term issues, avoiding carpal tunnel release.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Pediatric trauma
Background:
- Salter-Harris Type II fractures are common in children.
- Distal radius fractures can lead to median nerve compression.
- Prompt management is crucial for pediatric orthopedic injuries.
Observation:
- Three children presented with displaced distal radial epiphysis fractures (Salter-Harris Type II).
- All cases exhibited rapidly developing median nerve compression.
- Manipulation under anesthesia (MUA) was performed immediately.
Findings:
- Median nerve function was rapidly restored post-MUA in all patients.
- No late neurological sequelae were observed.
- Immediate MUA without carpal tunnel release proved effective.
Implications:
- Immediate MUA is a viable initial treatment for this specific pediatric fracture with nerve compression.
- Carpal tunnel release may not be necessary in the acute setting.
- Consideration for late median nerve exploration exists if deficits persist post-MUA.
Abstract:
Three children with grossly displaced Salter-Harris Type II fractures of the distal radial epiphysis underwent immediate manipulation under anaesthetic (MUA) because of rapidly developing median nerve compression. In each case nerve function was quickly restored with no late neurological sequelae. We believe that in children who sustain this injury with signs of median nerve compression, immediate MUA without carpal tunnel release is acceptable initial management. Late exploration of the median nerve can be considered should a neurological deficit persist.