Combined median and ulnar nerve palsy complicating distal radius fractures. 2018

Florence Dauzere, and Stéphanie Delclaux, and Thuy Trang Pham, and Michel Rongières, and Pierre Mansat
Orthopaedics Department, Toulouse Purpan Teaching Hospital, Toulouse, France.

Fractures of the distal radius only rarely give rise to complications in the immediate postoperative period. Combined median and ulnar nerve palsy is a complication that can be missed by the surgeon. Three cases diagnosed early after surgery are reported here. The patients were 15, 16, and 30 years of age, respectively. None had preoperative neurological deficits. The youngest patient was injured during sports and the other 2 patients during traffic accidents. All 3 patients had a displaced fracture of the distal radius combined with a fracture of the distal fourth of the ulna or ulnar styloid process and were treated by anterior plate fixation. Operative times were 47, 62, and 120minutes, respectively. Compartment syndrome was ruled out based on low pain intensity and absence of forearm tightness to palpation. The electrophysiological study performed 1 month post-injury in all 3 patients showed severe impairments of both median and ulnar nerve function. Median and ulnar nerve release surgery was performed in the 15-year-old 6 weeks post-injury. No nerve damage or fibrosis was seen during the procedure. All patients recovered fully within 3 months and had normal findings from follow-up electrophysiology testing after 6 months. Combined median and ulnar nerve palsy has rarely been reported and is among the rare complications of distal radial fractures that can develop in the event of a high-energy trauma and/or major displacement. Both previously published data and our experience indicate that surgical nerve release is unnecessary. Clinical recovery within 3 months is the rule. IV, case-reports.

UI MeSH Term Description Entries
D008297 Male Males
D011885 Radius Fractures Fractures of the RADIUS. Galeazzi Fracture,Galeazzi Fracture Dislocation,Radial Fractures,Dislocation, Galeazzi Fracture,Fracture Dislocation, Galeazzi,Fracture, Galeazzi,Fracture, Radial,Fracture, Radius,Radial Fracture,Radius Fracture
D001860 Bone Plates Implantable fracture fixation devices attached to bone fragments with screws to bridge the fracture gap and shield the fracture site from stress as bone heals. (UMDNS, 1999) Bone Plate,Plate, Bone,Plates, Bone
D005593 Fracture Fixation, Internal The use of internal devices (metal plates, nails, rods, etc.) to hold the position of a fracture in proper alignment. Osteosynthesis, Fracture,Fixation, Internal Fracture,Fixations, Internal Fracture,Fracture Fixations, Internal,Fracture Osteosyntheses,Fracture Osteosynthesis,Internal Fracture Fixation,Internal Fracture Fixations,Osteosyntheses, Fracture
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D014458 Ulna Fractures Fractures of the larger bone of the forearm. Fracture, Ulna,Fractures, Ulna,Ulna Fracture
D020127 Recovery of Function A partial or complete return to the normal or proper physiologic activity of an organ or part following disease or trauma. Function Recoveries,Function Recovery
D020423 Median Neuropathy Disease involving the median nerve, from its origin at the BRACHIAL PLEXUS to its termination in the hand. Clinical features include weakness of wrist and finger flexion, forearm pronation, thenar abduction, and loss of sensation over the lateral palm, first three fingers, and radial half of the ring finger. Common sites of injury include the elbow, where the nerve passes through the two heads of the pronator teres muscle (pronator syndrome) and in the carpal tunnel (CARPAL TUNNEL SYNDROME). Median Nerve Diseases,Medial Neuropathy, Distal,Median Mononeuropathy,Median Nerve Entrapment,Median Nerve Entrapment Neuropathy,Median Nerve Neuralgia,Median Nerve Neuropathy,Median Neuropathy, Proximal,Neuropathy, Median,Distal Medial Neuropathies,Distal Medial Neuropathy,Entrapment, Median Nerve,Median Mononeuropathies,Median Nerve Disease,Median Nerve Entrapments,Median Nerve Neuralgias,Median Nerve Neuropathies,Median Neuropathies,Mononeuropathy, Median,Nerve Disease, Median,Nerve Entrapment, Median,Nerve Neuropathy, Median,Neuralgia, Median Nerve,Neuropathy, Distal Medial,Neuropathy, Median Nerve,Neuropathy, Proximal Median,Proximal Median Neuropathies,Proximal Median Neuropathy

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