Related Experiment Videos
Ulnar nerve injury after closed forearm fractures in children
R Neiman1, B Maiocco, V F Deeney
1Department of Orthopedic Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA.
Insights
Ulnar nerve palsy in children with forearm fractures often resolves spontaneously with nonoperative care. Early neurologic examination is crucial for accurate diagnosis and to guide appropriate management, avoiding unnecessary surgery.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Neurology
Background:
- Forearm fractures in children can present with neurological complications.
- Ulnar nerve palsy is an uncommon but significant complication.
- Distinguishing nerve injury from compartment syndrome is critical for management.
Observation:
- Two pediatric patients developed ulnar nerve palsy following closed both-bone forearm fractures.
- Ulnar claw-hand deformity was observed within 7 weeks post-injury.
- No signs of ischemic compartment syndrome were present in either case.
Findings:
- Both patients experienced spontaneous resolution of ulnar nerve palsy by 20 weeks post-injury.
- Nonoperative management was successful in all observed cases.
- Immediate identification of nerve injury via neurologic examination prevented misdiagnosis.
Implications:
- Routine, careful neurologic examination before fracture reduction is recommended in pediatric forearm injuries.
- Detected ulnar nerve palsy likely results from nerve contusion and typically requires conservative management.
- This approach can prevent confusion with postreduction nerve entrapment or ischemic injuries, optimizing patient outcomes.
Abstract:
We treated two children with the unusual complication of ulnar nerve palsy after closed both-bone forearm fractures. Both patients developed an ulnar claw-hand deformity within 7 weeks of injury that resolved spontaneously by 20 weeks postinjury with nonoperative treatment. No patient showed any signs or symptoms of an ischemic compartment syndrome. Both nerve injuries were identified immediately at the time of fracture by a careful neurologic examination. This avoids confusion with a postreduction nerve entrapment injury or ischemic injury after a localized compartment syndrome, which may have considerably different treatments and outcomes. We recommend that a careful neurologic examination be recorded before any manipulative reduction of forearm fractures in children. If an ulnar nerve palsy is detected, it is probably a result of nerve contusion and should resolve without the need for surgical exploration.