Ihsan Kitta Muh, Ariandi Mirza, Nugroho Yosua Adi, Nur Adhika, Arden Ferdinand
Department of Orthopaedics and Traumatology, Faculty of Medicine of Hasanuddin University, Makassar, Indonesia; Lecturer of Medical Faculty of Muhammadiyah University, Makassar, Indonesia.
Department of Orthopaedics and Traumatology, Faculty of Medicine of Hasanuddin University, Makassar, Indonesia.
Int J Surg Case Rep. 2021 May;82:105896. doi: 10.1016/j.ijscr.2021.105896. Epub 2021 Apr 16.
Traumatic laceration of the radial nerve following supracondylar humerus fracture in the pediatric population is highly uncommon. Transection of the radial nerve is rare, and approximately 12.7% of all nerve injuries are categorized as neurapraxia that will resolve spontaneously.
We report a rare case of a 9-year-old boy presented with a right wrist drop after fell on an outstretched hand two weeks before. The radiological finding revealed a posteriorly displaced supracondylar humerus fracture. Intraoperatively, we found the radial nerve had lost its continuity and interposed by fibrotic tissue. We resect and do a direct repair of the nerve along with fixation of the fracture. At 4-months postoperative follow-up, the patient could fully extend his right thumb and wrist but retain a tingling sensation in the radial nerve distribution. At 1-year follow up the motor and sensory functions were normal without any complication.
Transection of radial nerve following the supracondylar fracture represents a rare case. The radial nerve was transected and interposed by scar tissue at the fracture site level, preventing spontaneous nerve regeneration. In a case of nerve transection, surgical repair is indicated.
In the case of supracondylar humerus fracture with posterior displacement, radial nerve transection could be associated with injuries. Authors favour nerve exploration with fracture stabilization performed as soon as possible when nerve injury is suspected. Appropriately managed, the outcome in the pediatric population is highly favourable.
小儿肱骨髁上骨折后桡神经创伤性撕裂极为罕见。桡神经横断伤少见，所有神经损伤中约12.7%被归类为神经失用症，可自行恢复。
我们报告一例罕见病例，一名9岁男孩在两周前伸手跌倒后出现右手垂腕。影像学检查发现肱骨髁上骨折向后移位。术中发现桡神经连续性中断，被纤维组织阻隔。我们切除神经并进行直接修复，同时固定骨折。术后4个月随访时，患者右手拇指和手腕可完全伸展，但桡神经分布区域仍有刺痛感。1年随访时，运动和感觉功能正常，无任何并发症。
肱骨髁上骨折后桡神经横断伤是罕见病例。桡神经在骨折部位水平被横断并被瘢痕组织阻隔，阻碍了神经的自发再生。对于神经横断伤病例，需进行手术修复。
对于伴有向后移位的肱骨髁上骨折，桡神经横断伤可能与损伤相关。作者主张在怀疑有神经损伤时尽早进行神经探查并稳定骨折。若处理得当，小儿患者的预后非常良好。
