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Entrapment of the median nerve following elbow dislocation
Insights
Median nerve entrapment in pediatric elbow dislocations is uncommon but often delayed. Early surgical intervention for nerve lesions can restore function, while severe cases may require nerve repair for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Neurology
Background:
- Elbow dislocation in children is a common pediatric orthopedic injury.
- Median nerve entrapment is an uncommon but serious complication of pediatric elbow dislocation.
- Delayed diagnosis of median nerve entrapment can lead to poorer outcomes.
Observation:
- Early signs include median nerve lesions and disproportionate pain post-reduction.
- Late signs involve complete median nerve lesions, elbow flexion contractures, and characteristic radiographic findings.
- Radiographic findings include a bony depression on the distal medial humeral cortex.
Findings:
- Prompt surgical decompression and neurolysis are effective when the median nerve is intact with electrical conduction.
- Resection and reanastomosis of the median nerve are indicated for severe entrapment with scar formation and absent conduction.
- Surgical intervention, including nerve repair, has yielded very good functional recovery in affected children.
Implications:
- Early recognition and timely surgical management are crucial for preventing long-term neurological deficits.
- This condition highlights the importance of thorough neurovascular assessment following pediatric elbow dislocations.
- Understanding the radiographic signs aids in earlier diagnosis and appropriate treatment planning for median nerve entrapment.
Abstract:
Entrapment of the median nerve in the elbow joint is an uncommon complication of dislocation of the elbow in children. Delay in diagnosis has been common. The early signs of median nerve entrapment are the presence of a lesion of the median nerve and pain greater than expected after reduction of an elbow dislocation. The late signs are the presence of a median nerve lesion that is usually complete, elbow flexion contracture, and a bony depression of the distal medial humeral cortex seen roentgenographically that corresponds to the location at which the median nerve travels posterior to the humerus and then enters the elbow joint. If the nerve is intact and one can obtain electrical conduction across the entrapped segment, freeing the nerve and neurolysis should result in recovery. On the other hand, if the nerve is replaced by scar, and there is no conduction across the elbow joint, resection of the damaged segment and reanastomosis is indicated, and has resulted in very good nerve function.