Iatrogenic Ulnar Nerve Injury post Laceration Suturing - An Unusual Presentation

Abstract

Introduction: Nerve entrapment while suturing a lacerated wound is a complication that is easily avoidable. We report a case low ulnar nerve palsy due to nerve entrapment while suturing a lacerated wound.

Case report: A 48 year old lady came with complaints of pain and a lacerated wound over the dorsomedial aspect of lower third of the left forearm. The lacerated wound was sutured elsewhere one week back. She had fracture of lower third of the ulna which was stabilised with plates and screws using a separate dorsal incision. She developed ulnar claw hand on the third postoperative day. Strength duration curve revealed neurotmesis of ulnar nerve. Ulnar nerve exploration was done and the nerve was found to be ligated at the site of original laceration. The ligature was released and nerve was found to be thinned out at the site. There was no neurological recovery at 5 months follow up and reconstruction procedures in form of tendon tranfer are planned for the patient.

Conclusion: This is a case of iatrogenic ulnar nerve palsy which is very rare in our literature. This can be easily avoided if proper care is taken while suturing the primary laceration. A nerve can be mistakenly sutured for a bleeding vein and proper exposure while suturing will be necessary especially at areas where nerves are superficial.

Keywords: iatrogenic; ulnar nerve palsy.

Fig 1

Pre-op X ray

Fig 2

Post op x ray

Fig 3

Clinical photo showing typical Ulnar Claw hand

Fig 4

SD curve Results at 3 weeks and 2 months of injury

Fig 5

Intra operative photographs showing knot on the Ulnar Nerve

Fig 6

The knot is pulled over a mosquito artery before cutting

Fig 7

Intra operative photographs showing knot on the Ulnar Nerve

Fig 8

SD curve at 3 months after neurolysis showing no improvement.