Median nerve entrapment in a callus fracture following a pediatric both-bone forearm fracture: A case report and literature review

Abstract

Forearm fractures are common injuries in childhood. Median nerve entrapment is a rare complication of forearm fractures, but several cases have been reported in the literature. This case report discusses the diagnosis and management of median nerve entrapment in a 13-year-old male who presented acutely with a both-bone forearm fracture and numbness in the median nerve distribution. Following the delayed diagnosis, surgical exploration revealed complete nerve entrapment and a nerve graft was performed.

The Management of Missed Median Nerve Laceration After Pediatric Both-Bone Forearm Fracture

“…Despite the high frequency of this fracture pattern, neurologic complications are exceedingly rare. This case is unique because of the significant delay to surgical intervention and severity of injury as compared with previous case reports 3,5 . In addition, to our knowledge, this is only the third case report that describes median nerve entrapment in the ulna fracture site, whereas most describe entrapment in the radial fracture site.…”

“…The “Matev sign” was first described in 1976, where a cortical irregularity may suggest nerve entrapment within bone 10 . In addition, a bony canal at the healed fracture site may also be associated with nerve entrapment 5,11 . Such findings may suggest this diagnosis and prompt earlier investigation, although the absence of these signs may not rule out nerve compromise.…”

“…Nerve injury has been well documented in supracondylar fractures but less so in forearm fractures. Few case reports have described injuries to the ulnar and median nerve after forearm fractures 2-5 . Multiple mechanisms have been described including direct contusion, laceration by a bony fragment, entrapment by abundant callus, and tethering by a bony spike, periosteum, scar tissue, or other soft tissues.…”

Median Nerve Entrapment Neuropathy in Pediatric Forearm Fracture

“… 1 2 Association of median nerve injury in pediatric forearm fractures is rare. 3 4 In our case, a progressive median nerve dysfunction developed over a period of time due to malunion and angulation at the fracture site as well as the wound biology (exuberant callus engulfing the nerve progressively). Our case highlights that even in a closed greenstick fracture, a rigid fixation using intramedullary nail or plate osteosynthesis would be a better option as compared with conservative approach in a diaphyseal fracture in preadolescence age group fulfilling the criteria for fixation.…”

Forearm fractures in children from Zadar region

“…Neoperativno liječenje podrazumijeva imobilizaciju udlagama i mirovanje podlaktice, često i lakta (6,7). Ipak ima prijeloma koji uvijek zahtijevaju operacijsko liječenje, dug oporavak i neizvjesnog su ishoda (8,9). Tako ozljede u području ploče rasta, bez obzira na ispravno provedeno liječenje, mogu ostaviti trajne posljedice.…”