Ulnar nerve palsy following closed fracture of the distal radius: a report of 2 cases

Abstract

Ulnar nerve palsy subsequent to a fracture of the distal radius is extremely rare compared to a median nerve injury. The lesion tends to occur in younger patents with a high-energy mechanism of injury and a severe injury pattern consisting of wide displacement, comminution, combined distal ulnar fracture and open fracture. The mechanism of injury can contribute to a direct contusion and traction, compression secondary to prolonged edema and tissue fibrosis, intraneural fibrosis and laceration. We report 2 cases of progressive ulnar nerve palsy subsequent to closed fractures of the distal radius. The neurological symptoms recovered in all cases who underwent nerve decompression and neurolysis at 2 or 3 months after the trauma. It is recommended that cases with high-energy, widely displaced or comminuted fractures of the distal radius be evaluated carefully for ulnar nerve as well as median nerve injury.

Keywords: Closed; Distal; Palsy; Radius fracture; Ulnar nerve.

Fig. 1

Anteroposterior and lateral radiographs show an intra-articular fracture of the distal radius with a fracture of the ulnar styloid process. The distal fragment of the radius was displaced dorsoradially.

Fig. 2

Photograph shows swelling, compression and adhesion by the surrounding tissue fibrosis of the ulnar nerve at the level of Guyon's canal.

Fig. 3

Anteroposterior and lateral radiographs show a severe intra-articular comminuted fracture of the distal radius with a fracture of the ulnar styloid process.

Fig. 4

Photograph shows swelling and compression by the surrounding tissue fibrosis of the ulnar nerve at the level of Guyon's canal.