Primary Radial Nerve Exploration Determined by Ultrasound in Pediatric Supracondylar Humerus Fracture: A Report of Two Cases

Abstract

We report two pediatric cases of radial nerve palsy caused by supracondylar fracture of the humerus requiring nerve exploration. The children had comparable conditions, palsy types (complete motor and partial sensory) and radiographic findings. The fracture in the first case was managed conservatively with closed reduction and percutaneous pinning but, while the patient eventually recovered from the partial sensory palsy, her motor palsy remained unchanged. In the second case, ultrasound assessment of the nerve prior to fixation indicated that surgical exploration was needed as it revealed tethering on the edge of the proximal fracture fragment. The nerve was released during an open reduction and the patient subsequently recovered from both sensory and motor palsies. Ultrasonography proved essential in the initial clinical assessment by determining how to proceed. We recommend primary nerve exploration when ultrasound findings show entrapment or tethering of the radial nerve.