Median Nerve Injury
Median nerve injuries in children are rare but can lead to devastating functional deficits if they are not recognized and treated promptly. These injuries most commonly occur secondary to fractures, dislocations, penetrating wounds, and lacerations. As the neurologic evaluation of children can be challenging, clinicians should maintain a high level of suspicion for median nerve injury in children presenting with injuries in proximity to the anatomic course of the median nerve. An initial period of observation for patients presenting with median nerve palsy following closed fractures or gunshot injuries may be warranted. However, in patients who demonstrate motor or sensory deficits in the distribution of the median nerve following open fractures, penetrating wounds, or lacerations, a low threshold for early exploration is appropriate. EMG/NCV studies can help guide treatment in patients with delayed return of median nerve function.
Options for surgical intervention depend upon the length of the nerve defect and the time elapsed from injury to operative intervention. For patients with median nerve defects ≤2 cm, options include primary epineural or fascicular repair or use of a synthetic conduit. For patients with median nerve defects ≥2 cm, options include allograft, autograft, or nerve transfers. Patients with late presentations or who have undergone a failed nerve repair are candidates for tendon transfers to restore lost median nerve motor function. Children are generally believed to have better potential for motor and sensory recovery than adults following injury to the median nerve.
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