Related Experiment Video
Updated: Jul 5, 2025
Metacarpal Small Incision for Carpal Tunnel Syndrome
Published on: April 5, 2024
Entrapment of median nerve after elbow fracture dislocations: expected surgical time frame based on cadaver study
Yener Yoğun1, Uğur Bezirgan2, Tülin Şen Esmer3
1Hand Surgery Unit, Orthopedics and Traumatology Department, Ankara University Faculty of Medicine, Ankara, Turkey. yogunyener@gmail.com.
Insights
Median nerve palsy after pediatric elbow dislocation can lead to poor outcomes if diagnosis is delayed. This study suggests thumb flexion recovery may occur within 4 months post-injury if the nerve isn't entrapped, guiding surgical timing.
Area of Science:
- Orthopedic Surgery
- Neurology
- Pediatric Traumatology
Background:
- Median nerve injuries complicate approximately 3% of pediatric elbow fracture dislocations.
- Delayed diagnosis and treatment of these injuries can result in poor functional outcomes.
- Optimal surgical timing is a critical prognostic factor for median nerve recovery.
Purpose of the Study:
- To present three cases of pediatric median nerve palsy following elbow dislocation with delayed presentation.
- To determine an objective timeframe for surgical exploration based on anatomical measurements.
- To correlate anatomical findings with expected nerve regeneration rates.
Main Methods:
- Case series of three pediatric patients with median nerve palsy post-elbow dislocation.
- Anatomical cadaver study involving dissection of 20 upper extremities to measure distances related to flexor pollicis longus (FPL) innervation.
- Calculation of expected FPL reinnervation time based on nerve healing rates (1 mm/day).
Main Results:
- The mean distance from the medial epicondyle to FPL motor innervation was 101.99 mm (range: 87.5-134.2 mm).
- Including the longest nerve length, the mean distance was 110.83 mm (range: 87.5-148.1 mm).
- Based on nerve healing at 1 mm/day, FPL recovery is estimated to take approximately 4 months.
Conclusions:
- Thumb flexion recovery following median nerve palsy after elbow dislocation may be expected within 4 months if the nerve is not entrapped.
- This cadaver-based study provides an objective timeframe for evaluating FPL reinnervation in pediatric elbow injuries.
- The findings emphasize the importance of timely surgical intervention for optimal outcomes in pediatric median nerve injuries.
Introduction:
Median nerve injuries occur in approximately 3% of pediatric elbow fracture dislocations. These rare injuries can be difficult to diagnose, and the results are poor in delay cases. Surgical timing is one of the most important prognostic factors. We aimed to present three patients with median nerve palsy who were referred to our clinic late, and according to these cases, we emphasized the expected time frame for exploration based on our anatomical cadaver study.
Materials And Methods:
Between 2008 and 2010, three patients were referred to our clinic because of median nerve paralysis after a treated elbow dislocation. The mean interval between injury and referral was 15 (min: 13-max: 18) months, and the mean age of the patients was 15 (13-18) years. Neurolysis was performed in two patients, and for the third patent, after neurolysis, axonal continuity was observed to be disrupted so sural nerve grafting was performed with four cables. Tendon transfers were performed in all patients. A total number of 20 upper extremities of 10 cadavers were dissected. Due to its proximal innervation and ease of assessment, the muscle innervation of the flexor pollicis longus (FPL) was planned to be evaluated. The distance from the medial epicondyle is calculated in the cadaver study where the nerve injury is found.
Results:
The mean length from the medial epicondyle to the motor innervation of FPL was calculated in each specimen and found to be 101.99 millimeters (mm) (range: 87.5-134.2). The mean longest innervation of FPL was 110.83 mm from (range 87.5-148.1) the medial epicondyle calculated by including each specimens longest nerve length. Knowing that the healing time of a nerve lesion is 1 mm per day, we calculated that the recovery of FPL would take approximately 4 months.
Conclusion:
When nerve healing is expected to be 1 mm a day in axonotmesis type injury, after the median nerve palsy following elbow dislocation, thumb flexion should be achieved in the following 4 months generally if the nerve was not entrapped in the joint. This cadaver-based study objectively defined how long to wait for the innervation of the FPL in median nerve injuries in elbow fracture dislocations.
