Pediatric Both Bone Fracture Leading to Median Nerve Entrapment: A Case Report

Both-bone forearm fractures are common in pediatric patients and most often result from a fall onto an outstretched hand. Although rare, nerve entrapments, particularly of the median nerve, can occur, especially following closed reduction.

We present the case of a 13-year-old male who sustained a both-bone forearm fracture while on vacation in Mexico. The injury was managed with closed reduction and casting. Despite appropriate treatment, the patient developed progressive numbness, tingling, and thenar atrophy in the median nerve distribution. Electromyography and nerve conduction studies confirmed significant median nerve dysfunction. Surgical exploration revealed the median nerve entrapped in dense scar tissue with an hourglass deformity approximately 18 cm proximal to the wrist. The patient underwent successful median nerve neurolysis and open carpal tunnel release. Postoperatively, he experienced steady neurological recovery, with full restoration of motor and sensory function by the 8-month follow-up. This case is notable for the delayed onset of median nerve entrapment symptoms despite proper fracture alignment and management. It highlights the potential for dense periosteal scarring to cause nerve compression even in the absence of radiographic abnormalities. Comparison with similar cases in the literature emphasizes the importance of early recognition and timely surgical intervention.

This case highlights the importance of maintaining a high index of suspicion for nerve entrapment in pediatric both-bone fractures, even when reduction appears satisfactory. Early diagnosis and surgical decompression are crucial to prevent long-term functional deficits.