Presentation
Unwitnessed fall onto elbow. Ulnar nerve paresthesia and weakness.
Patient Data
Flexion type supracondylar humerus fracture with anterior displacement of distal humerus. There is lateral displacement with a comminuted component to the fracture on the AP image.
(Radiograph was incorrectly marked as left, but confirmed to be right elbow)
Case Discussion
Flexion type supracondylar fractures are rare in the context of all supracondylar fractures, representing between 2-4%. There are varied data on the presence of ulna nerve injury for flexion type fractures, suggested between 10-20%. Of those identified with ulna nerve neuropraxia on presentation, there is a much higher likelihood of requiring an open reduction to mobilize the ulna nerve and stabilize the fracture compared to those without ulna nerve injury on examination.
This patient had a significant ulna nerve motor and sensory deficit pre-operatively and underwent an open reduction. The ulna nerve was tethered across the fracture and mobilized during the reduction. Two medial and two lateral percutaneous Kirschner wires were used to immobilize the fracture along with an above elbow backslab in the acute post-operative period.
The patient's ulna nerve palsy was slow to recover post-operatively, with supportive hand therapy utilized while the nerve function returned.
There is usually no indication for diagnostic studies to assess the nerve following this injury as the majority resolve spontaneously. In this instance, the ulna nerve was visualized to be intact, increasing the confidence that the neuropraxia should resolve without long-term complication.
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