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Distal Nerve Transfer for Refractory Ulnar Neuropathy After a Pediatric Elbow Fracture: Expanding the Role of

Rafael Rocha1, Cristina Alves1, Maria Pia Monjardino1

  • 1Unidade Local de Saúde de Coimbra, EPE, Portugal.

Hand (New York, N.Y.)
|January 23, 2026
PubMed

Insights

This case study highlights a novel surgical technique for pediatric ulnar nerve palsy following medial epicondyle fractures. Supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer successfully restored function in a young gymnast.

Area of Science:

  • Orthopedics
  • Neurology
  • Pediatric Surgery

Background:

  • Medial epicondyle fractures are common in children, with ulnar nerve palsy occurring in up to 16% of cases.
  • Delayed or progressive neurologic symptoms can persist despite initial conservative or surgical management.
  • Distal nerve transfers show promise in adults but are less established in pediatric chronic ulnar neuropathy.

Purpose of the Study:

  • To report the first pediatric case of supercharged end-to-side (SETS) anterior interosseous nerve (AIN) to ulnar motor nerve transfer.
  • To evaluate the efficacy of this technique in a pediatric patient with chronic ulnar neuropathy after medial epicondyle fracture and failed decompression.
  • To assess functional recovery of hand strength, motor coordination, and sensation.

Main Methods:

  • A 13-year-old gymnast with delayed ulnar nerve palsy post-medial epicondyle fracture underwent anterior ulnar nerve transposition.
  • Persistent deficits led to a second surgery involving ulnar nerve decompression and SETS AIN-to-ulnar motor nerve transfer.
  • Functional outcomes were assessed using QuickDASH scores and clinical evaluation of hand function.

Main Results:

  • The patient experienced persistent motor and sensory deficits after initial transposition (QuickDASH 90.6).
  • Following SETS AIN-to-ulnar motor nerve transfer, significant recovery in hand strength and fine motor coordination was observed.
  • Ulnar nerve-mediated sensation improved, and QuickDASH score decreased to 6.8 at 4-year follow-up, indicating near-complete functional recovery.

Conclusions:

  • SETS AIN-to-ulnar motor nerve transfer is a viable strategy for pediatric chronic ulnar neuropathy, even after failed prior surgeries.
  • This technique can enhance intrinsic hand function beyond conventional reinnervation timelines in pediatric patients.
  • This case expands the potential treatment options for complex pediatric ulnar nerve injuries secondary to fractures.

Keywords:
medial epicondyle fracturenerve transferspediatric elbow fractureulnar nerve

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