Kang Dong-Geun, Lee Dong Hyun, Im Jin-Hyung
Department of Orthopedic Surgery, Gyeongsang National University, College of Medicine and Gyeongsang National University Changwon Hospital, Changwon-si, Republic of Korea.
Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Medicine (Baltimore). 2025 Jul 25;104(30):e43322. doi: 10.1097/MD.0000000000043322.
Pediatric distal humeral diaphyseal fractures are rare and challenging to manage due to anatomical and biomechanical complexities. In addition, humeral shaft fractures in adults are often accompanied by radial nerve paralysis (RNP), but there are no studies on the incidence or treatment of pediatric humeral shaft fractures accompanied by RNP in toddlers. The authors present the outcomes of closed reduction and intramedullary nailing using Kirschner wires (K-wires) for high-energy distal humeral metaphyseal-diaphyseal open fractures accompanied by RNP in a toddler. This case report aims to highlight an effective surgical approach and its outcomes in a toddler, providing insights for clinicians facing similar scenarios.
A 23-month-old boy was referred to our emergency room after several hospital visits. He complained of pain in his right arm and presented wrist drop due to a crushing injury by a conveyor belt. A 1 cm open wound was located at the lateral side of the elbow.
The patient was diagnosed with an open displaced fracture in the distal third of the right humerus on radiographic examination and RNP was diagnosed on the basis of physical examination.
The authors initially attempted open reduction and internal fixation of the fracture using a Steinmann pin after radial nerve exploration, which confirmed continuity of the normal radial nerve, but fixation failed. Reduction loss and displacement progressed with pin migration the day after surgery, and revision surgery was selected. Closed reduction and intramedullary nailing using K-wires were performed on day 2 after the primary surgery.
The patient recovered his ability to extend the wrist and metacarpophalangeal joint approximately 3 weeks after surgery. At the 1-month and 6-month follow-up, the fracture had healed, and radial nerve function had recovered completely.
Intramedullary nailing using K-wires for metaphyseal-diaphyseal fractures of the humerus in toddlers is an effective operative treatment. Among them, high-energy open fractures accompanied by radial nerve palsy might require nerve exploration.
小儿肱骨远端骨干骨折较为罕见，由于解剖结构和生物力学的复杂性，其治疗具有挑战性。此外，成人肱骨干骨折常伴有桡神经麻痹（RNP），但关于幼儿肱骨骨干骨折合并RNP的发生率及治疗的研究尚无报道。作者介绍了一名幼儿因高能肱骨远端干骺端-骨干开放性骨折合并RNP，采用克氏针（K针）进行闭合复位和髓内钉固定的治疗结果。本病例报告旨在突出一种有效的手术方法及其在幼儿中的治疗效果，为面临类似情况的临床医生提供参考。
一名23个月大的男孩在多次就诊后被转诊至我们的急诊室。他因传送带挤压伤导致右臂疼痛，并出现垂腕。肘部外侧有一个1厘米的开放性伤口。
经X线检查，患者被诊断为右肱骨远端三分之一处开放性移位骨折，根据体格检查诊断为RNP。
作者最初在探查桡神经后，尝试使用斯氏针进行骨折的切开复位内固定，确认桡神经正常连续性，但固定失败。术后第二天，随着钢针移位，复位丢失和移位进展，遂选择再次手术。在初次手术后第2天进行了闭合复位和K针髓内钉固定。
术后约3周，患者恢复了伸腕和掌指关节的能力。在1个月和6个月的随访中，骨折已愈合，桡神经功能完全恢复。
对于幼儿肱骨干骺端-骨干骨折，使用K针进行髓内钉固定是一种有效的手术治疗方法。其中，高能开放性骨折合并桡神经麻痹可能需要进行神经探查。
