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Tardy Ulnar Nerve Palsy.

Guy Rubin1, Hagay Orbach, Noam Bor

  • 1From the Orthopedic Department (Dr. Rubin, Dr. Orbach, Dr. Bor, and Prof. Rozen), Emek Medical Center, Afula, Israel, and the Faculty of Medicine (Dr. Rubin, Dr. Bor, and Prof. Rozen), Technion, Haifa, Israel.

The Journal of the American Academy of Orthopaedic Surgeons
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Summary

Tardy ulnar nerve palsy, a delayed neuropathy after elbow injury, often stems from pediatric fractures causing cubitus valgus. Surgical decompression and osteotomy yield successful outcomes.

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Area of Science:

  • Orthopedics
  • Neurology
  • Pediatric Surgery

Background:

  • Tardy ulnar nerve palsy is a chronic condition resulting from delayed ulnar neuropathy post-elbow injury.
  • Commonly linked to nonunion of pediatric lateral condyle fractures, leading to progressive cubitus valgus deformity.
  • Other elbow traumas like supracondylar, medial condyle, olecranon, or radial head fractures can also cause this condition.

Purpose of the Study:

  • To describe the etiology, clinical presentation, and management of tardy ulnar nerve palsy in children.
  • To highlight the association between specific pediatric elbow fractures and the development of ulnar neuropathy.
  • To review diagnostic methods and treatment strategies for this condition.

Main Methods:

  • Comprehensive patient history and physical examination.
  • Nerve conduction studies to assess ulnar nerve function.
  • Elbow imaging studies (X-rays, CT) to evaluate bony deformities and fracture healing.

Main Results:

  • Delayed ulnar nerve symptoms appear as cubitus valgus deformity worsens with growth.
  • Various pediatric elbow fractures, with or without deformity, are associated with tardy ulnar nerve palsy.
  • Surgical intervention, including ulnar nerve decompression and corrective osteotomy, demonstrates high success rates.

Conclusions:

  • Tardy ulnar nerve palsy is a significant complication of pediatric elbow trauma, particularly lateral condyle fractures.
  • Accurate diagnosis relies on clinical assessment, electrodiagnostic tests, and imaging.
  • Surgical management offers effective treatment with favorable prognoses.