Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Orthopedic Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan.
J Hand Surg Asian Pac Vol. 2021 Jun;26(2):284-289. doi: 10.1142/S2424835521720097.
We report two pediatric cases of radial nerve palsy caused by supracondylar fracture of the humerus requiring nerve exploration. The children had comparable conditions, palsy types (complete motor and partial sensory) and radiographic findings. The fracture in the first case was managed conservatively with closed reduction and percutaneous pinning but, while the patient eventually recovered from the partial sensory palsy, her motor palsy remained unchanged. In the second case, ultrasound assessment of the nerve prior to fixation indicated that surgical exploration was needed as it revealed tethering on the edge of the proximal fracture fragment. The nerve was released during an open reduction and the patient subsequently recovered from both sensory and motor palsies. Ultrasonography proved essential in the initial clinical assessment by determining how to proceed. We recommend primary nerve exploration when ultrasound findings show entrapment or tethering of the radial nerve.
我们报告了两例因肱骨髁上骨折导致的桡神经麻痹的儿科病例，需要进行神经探查。这两个孩子的情况相似，存在相同的麻痹类型（完全运动性和部分感觉性）和影像学表现。第一个病例的骨折采用闭合复位和经皮钢针固定进行保守治疗，但尽管患者最终从部分感觉性麻痹中恢复，但她的运动性麻痹仍未改变。在第二个病例中，在固定之前对神经进行超声评估表明需要进行手术探查，因为超声显示近端骨折碎片边缘有束缚。在开放性复位过程中松解神经，随后患者从感觉性和运动性麻痹中都恢复了。超声检查在确定治疗方案的初始临床评估中非常重要。当超声检查发现桡神经受压或束缚时，我们建议进行初次神经探查。
