Nerve palsies related to pediatric upper extremity fractures

In every child who has a fracture, neurologic examination is essential at initial assessment so that early diagnosis of nerve injury can be made. Electrodiagnostic studies may be helpful in diagnosis when the examination is equivocal and in follow-up to look for signs of recovery. In a patient who has neurologic deficits associated with a fracture, nerve exploration should be considered for open fractures, fractures that require open reduction, and palsies that develop after fracture reduction. For closed fractures associated with nerve palsy at the time of initial injury, observation and serial examination after reduction is recommended. If there is no return of nerve function on examination or electrodiagnostic testing by 4 months, operative exploration is indicated.