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Orthopaedics & Traumatology: Surgery & Research
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le samedi 25 août 2018
Doi : 10.1016/j.otsr.2018.04.026
Received : 23 October 2017 ;  accepted : 3 April 2018
Combined median and ulnar nerve palsy complicating distal radius fractures
 

Florence Dauzere a, Stéphanie Delclaux a, , Thuy Trang Pham b, Michel Rongières a, Pierre Mansat a
a Orthopaedics Department, Toulouse Purpan Teaching Hospital, Toulouse, France 
b Orthopaedics Pediatric Department, Toulouse Purpan Teaching Hospital, Toulouse, France 

Corresponding author. Orthopédie, CHU de Toulouse Purpan, TSA 40031, place du Dr Baylac, 31059 Toulouse cedex 9, France.Orthopédie, CHU de Toulouse PurpanTSA 40031, place du Dr BaylacToulouse cedex 931059France
Abstract
Background

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.

Materials and methods

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.

Results

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.

Discussion

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.

Level of evidence

IV, case-reports.

The full text of this article is available in PDF format.

Keywords : Fracture, Radius, Palsy




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