[Paralysis of the radial nerve and supracondylar fractures of the humerus in children. A study of a series of 11 cases]

Abstract

Eleven radial nerve paralyses, associated with supracondylar fractures of the humerus in children, are reported: 2 incomplete motor, 5 complete motor, 2 complete motor and partial sensory and 2 complete motor and total sensory. The palsy was noticed before any treatment in 8 cases. In the 3 other cases, the palsy was secondary to difficult and repetitive closed reduction manoeuvers. The fractures were all of the extension type, grade III in 2 cases and IV in 9 cases. The displacement of the distal fragment was posterior and medial in 8 cases. Initial treatment of the fracture was conservative in 5 cases with 2 failures and surgical in 6 cases. Nerve function recovery always followed the same sequence: extensor muscles of the wrist, then extensor muscles of the fingers and at last, extensor muscles of the thumb. Time required for full recovery varied from 4 to 6 months. Open reduction and nerve control did not seem to be better than closed reduction with regard to the required time for neurological recovery and its quality. The indications depend on the extension of the paralysis. If radial palsy is incomplete, the first therapeutic step is closed reduction, followed by surgical reduction if not possible. A primary surgical approach is proposed in cases of complete sensory and motor paralysis because of the operative findings of contusion and incarceration of the nerve which may be aggravated by blind manoeuvers.