Median Nerve Entrapment after Supracondylar Humeral Fracture in a Young Child

Abstract

Median nerve entrapment after supracondylar humeral fracture in children is rare. We report a case of Gartland type III supracondylar humeral fracture complicated by an entrapment of the median nerve following closed reduction and percutaneous pinning in a 5-year-old child. The diagnosis of entrapment was made 14 months post injury following progressive motor and sensory palsy. Resection and end-to-end suture were performed, leading to complete sensory and motor recovery eight months later. This nerve complication is often unnoticed and should be suspected systematically before and after reduction of all displaced supracondylar humeral fracture in children. The indication of resection-suture or nerve graft depends on the entrapment and the delay of the palsy.

Figure 1

Gartland type III SCHF.

Figure 2

Lateral percutaneous pinning: front and side view.

Figure 3

Complete remodeling of the distal end of the humerus: 6 months postoperatively—front and side view.

Figure 4

T1 MRI sequence showing median nerve entrapment upstream of the bone callus (white arrow).

Figure 5

T2 DPFS MRI sequence showing hypertrophy (white arrow) and median nerve entrapment within the consolidated fracture.

Figure 6

Entrapment of the hypertrophic proximal end of the median nerve (white arrow) within the consolidated fracture (black arrow) and fibrosis with atrophy of the distal end of the median nerve (blue arrow).

Figure 7

Post resection view flush of the bone callus of the proximal end (black arrow) and of the atrophic fibrosis part along a 1.5 cm section next to the distal end (white arrow) of the median nerve.

Figure 8

Terminoterminal direct type suture of the median nerve (black arrow) reinforced with biological sealant (white arrow).