A Rare Case of Median Nerve Entrapment within the Bone After Surgical Treatment of a Pediatric Supracondylar Humerus Fracture

Zinger, Gershon; Remeileh, Sameh Abu; Bregman, Alexander; Yudkevich, Genady

doi:10.2106/jbjs.cc.20.00059

Cited by 3 publications

(3 citation statements)

References 7 publications

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“…Holmes et al reported that on the cadaveric dissection of a 56-year-old man who suffered a humeral fracture at the age of 9 years, there was a median nerve entrapment in the distal humerus as that of our patient 12 . Meanwhile, the isolated median nerve entrapment in the humerus after pediatric SCHF was reported in only 4 cases (Table I) [4][5][6][7] . All fractures were displaced severely in extension-type fractures.…”

Section: Discussionmentioning

confidence: 99%

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High Median Nerve Entrapment by Fracture Callus in Surgically Treated Pediatric Supracondylar Humeral Fracture

Yano

Ishiko

Iida

et al. 2022

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Case: We describe a patient with incomplete high median nerve palsy after surgical treatment of pediatric supracondylar humeral fracture (SCHF). Preoperative images after 11 months after the surgical treatment of the SCHF showed rotational deformity and an isolated median nerve entrapped between the proximal humerus anteriorly and callus posteriorly in the bony tunnel of the distal humerus. Two years after neurolysis, he showed clinical recovery. Four cases similar to our case were reported previously. Conclusion:Common pediatric fractures may cause unusual neuropathy. Rotational deformity of fracture might be an important factor for isolated median nerve entrapment after SCHF.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B787).

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Section: Discussionmentioning

confidence: 99%

“…Four cases of an isolated median nerve entrapment into the humerus after pediatric SCHF have been reported [4][5][6][7] . However, the underlying mechanism of the involvement of the median nerve remains unclarified.…”

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confidence: 99%

High Median Nerve Entrapment by Fracture Callus in Surgically Treated Pediatric Supracondylar Humeral Fracture

Yano

Ishiko

Iida

et al. 2022

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“…The median nerve lesions that have been preoperatively untreated may later on require the neurolysis of a partially intact clinical and electrical nerve whose activity is improved in terms of motor and sensory capacities [38]. In very young children, paralysis of the median nevus after PP and the association with paresthesias may result in serious consequences.…”

Section: Indication On "Double X" Fixationmentioning

confidence: 99%

“Double X” Cross Fixationin Paediatric Supracondylar Humerus Fractures: A 20-Year Expertise and 94 Surgical Interventions

Burnei¹,

Burnei²,

Fd³

et al. 2020

ACMCR

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Closed injuries of the median nerve in children: tactics, variants of surgery

Govenko,

Snischuk,

Klimkin

et al. 2023

Russian Journal of Pediatric Surgery

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Purpose. To demonstrate intraoperative variants of closed injuries of the median nerve, possible types of surgical correction, their correlation with preoperative clinical, electromyographic and ultrasound findings.Material and methods. 10 children with closed injuries of the median nerve were examined with a score scale, electroneuromyography and ultrasound. The obtained findings were compared with intraoperative findings.Results. Complete and deep impairments of median nerve conduction were revealed after supra-, trans-condylar fractures of the humerus and dislocation in the elbow joint many weeks and months later after the date of injury. 6 out of 10 children were operated on because of the lack dynamics in neurological symptoms. At the same time, in two cases ultrasound examination showed that the nerve trunk was completely involved in the callus and strangled; this finding corrected surgical tactics. Intraoperatively , three variants of median nerve injury were described: (1) the nerve has an angular deformation, is surrounded by bone or scar tissues, compressed and fixed to the underlying bone or soft tissues without nerve bundles damage; (2) in addition to the abovementioned, the nerve has damaged bundles with various degrees of damage; (3) the nerve is located in scars in its usual position with intact bundles and without a distinct neuroma formation.Conclusion. Comparison of clinical, edectroneuromyographic and ultrasound findings plus intraoperatively identified variants of nerve damage allows to choose a proper surgical tactics - decompression and neurolysis with restoration of the nerve natural position in tissues, microsurgical partial autoplasty or microsurgical suture of the nerve trunk. Ultrasound examination helps to clarify indications for surgery.

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A Rare Case of Median Nerve Entrapment within the Bone After Surgical Treatment of a Pediatric Supracondylar Humerus Fracture

Cited by 3 publications

References 7 publications

High Median Nerve Entrapment by Fracture Callus in Surgically Treated Pediatric Supracondylar Humeral Fracture

High Median Nerve Entrapment by Fracture Callus in Surgically Treated Pediatric Supracondylar Humeral Fracture

“Double X” Cross Fixationin Paediatric Supracondylar Humerus Fractures: A 20-Year Expertise and 94 Surgical Interventions

Closed injuries of the median nerve in children: tactics, variants of surgery

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