Complete laceration of the radial nerve following supracondylar humerus fracture is a rare finding.
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Radial nerve injury with wrist-drop is seen two weeks after the injury.
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The sensory disturbance is shown as anaesthesia in the radial nerve distribution.
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Neurorrhapy was done in conjunction with the open reduction internal fixation of the fracture.
Abstract
Introduction and Importance
Traumatic laceration of the radial nerve following supracondylar humerus fracture in the pediatric population is highly uncommon. Transection of the radial nerve is rare, and approximately 12.7% of all nerve injuries are categorized as neurapraxia that will resolve spontaneously.
Case presentation
We report a rare case of a 9-year-old boy presented with a right wrist drop after fell on an outstretched hand two weeks before. The radiological finding revealed a posteriorly displaced supracondylar humerus fracture. Intraoperatively, we found the radial nerve had lost its continuity and interposed by fibrotic tissue. We resect and do a direct repair of the nerve along with fixation of the fracture. At 4-months postoperative follow-up, the patient could fully extend his right thumb and wrist but retain a tingling sensation in the radial nerve distribution. At 1-year follow up the motor and sensory functions were normal without any complication.
Clinical Discussion
Transection of radial nerve following the supracondylar fracture represents a rare case. The radial nerve was transected and interposed by scar tissue at the fracture site level, preventing spontaneous nerve regeneration. In a case of nerve transection, surgical repair is indicated.
Conclusion
In the case of supracondylar humerus fracture with posterior displacement, radial nerve transection could be associated with injuries. Authors favour nerve exploration with fracture stabilization performed as soon as possible when nerve injury is suspected. Appropriately managed, the outcome in the pediatric population is highly favourable.
