Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-do, Republic of Korea.
Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Hallym University, Hwaseong-si, Gyeonggi-do, Republic of Korea.
Acta Orthop Traumatol Turc. 2022 Sep;56(5):350-353. doi: 10.5152/j.aott.2022.22062.
Supracondylar fracture of the humerus is one of the most common fractures seen in children, and posteromedial displacement of the distal fragment in extension-type supracondylar humerus fractures can cause injury to the radial nerve. A 6-year old girl who presented with symptoms of radial nerve injury after a supracondylar fracture of the right humerus with complete posteromedial displacement of the distal fragment (Gartland type III) underwent surgery where closed reduction and percutaneous pinning was performed. The patient was routinely followed up and at 6 months postoperatively no neurological improvement was seen. Exploratory surgery revealed complete discontinuation of the radial nerve at the fracture site and entrapment of the nerve stumps in healed bone callus. A gap of 2 cm was observed between nerve stumps, and sural nerve cable grafting was performed with good results. If neurological symptoms do not improve over time, appropriate differential diagnosis and, if necessary, exploratory surgery should be considered. Despite limited reports and their conflicting outcomes, sural nerve cable grafting could be a useful option to bridge the gap of discontinued nerve injury. Level of Evidence: Level IV, Case Report.
肱骨髁上骨折是儿童中最常见的骨折之一，伸展型肱骨髁上骨折中远端骨折块后内侧移位可导致桡神经损伤。一名 6 岁女孩因右侧肱骨髁上骨折伴完全后内侧移位（Gartland Ⅲ型）出现桡神经损伤症状，接受了闭合复位和经皮克氏针固定手术。患者常规随访，术后 6 个月未见神经功能改善。探查手术显示桡神经在骨折部位完全中断，神经残端被愈合的骨痂嵌顿。神经残端之间观察到 2 厘米的间隙，采用腓肠神经电缆移植术取得了良好的效果。如果神经症状随时间推移没有改善，应考虑适当的鉴别诊断和必要时的探查手术。尽管报告有限且结果相互矛盾，但腓肠神经电缆移植术可能是一种有用的选择，可以桥接中断神经损伤的间隙。证据水平：IV 级，病例报告。
