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[Delayed radial paralysis after Monteggia fracture--a case report]
1Universitätsklinik für Unfallchirurgie Innsbruck, Anichstrasse 35, 6020 Innsbruck, Osterreich. hacklwol@hotmail.com
Der Unfallchirurg
|July 23, 2002
Summary
Delayed posterior interosseous nerve palsy occurred 27 years after an untreated Monteggia fracture. Surgical release of the entrapped radial nerve led to full neurological recovery.
Area of Science:
- Orthopedic Surgery
- Neurology
Background:
- Monteggia fractures, a dislocation of the radial head with associated ulna fracture, can rarely cause neural complications.
- Delayed neurological deficits are uncommon, especially decades after the initial injury.
Observation:
- A 33-year-old man presented with delayed posterior interosseous nerve palsy 27 years after an untreated Monteggia fracture.
- The palsy, characterized by wrist and finger extension impairment, was likely triggered by minor trauma.
- Conservative treatment, including physiotherapy and electrotherapy, failed to resolve the symptoms.
Findings:
- Surgical exploration revealed the radial nerve was entrapped by a thickened arcade of Frohse.
- Release of the entrapped nerve, with the radial head remaining dislocated, resulted in complete neurological recovery.
- Full recovery of nerve function was observed 9 months post-surgery.
Implications:
- This case highlights the potential for late-onset nerve complications in long-standing, untreated Monteggia fractures.
- Surgical decompression of the radial nerve is an effective treatment for delayed posterior interosseous nerve palsy.
- Preserves the possibility of successful nerve recovery even after a significant delay.