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Radial Nerve Injury

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The Pediatric Upper Extremity

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Abstract

Radial nerve palsy in the child can be attributed to a variety of traumatic causes, including humeral shaft, supracondylar humerus, and Monteggia fractures, as well as congenital and pathologic etiologies. Most pediatric injuries to the radial nerve have a favorable prognosis with observation, protective splinting, and therapy. Patients who fail to recover neurologic function after 3–6 months, however, require surgical exploration for neurolysis, nerve repair, or nerve grafting. Primary repair has better outcomes than grafting or nerve transfers, provided that a well-vascularized tissue bed is available and minimal tension is placed on the repair.

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References

  • Abu-Jayyab Z, Abu-Zidan F, Marlovits S. Fracture dislocation of the lateral condyle and medial epicondyle of the humerus associated with complete radial nerve transection. J Pak Med Assoc. 2011;61(9):920–1.

    PubMed  Google Scholar 

  • Alsubhi FS, Althunyan AM, Curtis CG, Clarke HM. Radial nerve palsy in the newborn: a case series. CMAJ. 2011;183(12):1367–70.

    Article  PubMed Central  PubMed  Google Scholar 

  • Amillo S, Barrios RH, Martínez-Peric R, Losada JI. Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma. 1993;7(3):211–5.

    Article  CAS  PubMed  Google Scholar 

  • Austin R. Tardy palsy of the radial nerve from a Monteggia fracture. Injury. 1976;7(3):202–4.

    Article  CAS  PubMed  Google Scholar 

  • Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010;30(3):253–63.

    Article  PubMed  Google Scholar 

  • Birch R. Nerve repair. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2010. p. 1035–74.

    Google Scholar 

  • Birch R, Achan P. Peripheral nerve repairs and their results in children. Hand Clin. 2000;16(4):579–95.

    CAS  PubMed  Google Scholar 

  • Brown IC, Zinar DM. Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop. 1995;15(4):440–3.

    Article  CAS  PubMed  Google Scholar 

  • Clark WL, Trumble TE, Swiontkowski MF, Tencer AF. Nerve tension and blood flow in a rat model of immediate and delayed repairs. J Hand Surg Am. 1992;17(4):677–87.

    Article  CAS  PubMed  Google Scholar 

  • Colditz J. Splinting for radial nerve palsy. J Hand Ther. 1987;1:18–23.

    Article  Google Scholar 

  • Coppotelli BA, Lonsdale JD, Kass E. Sclerema neonatorum complicated by radial nerve palsy following nontraumatic delivery. Mt Sinai J Med. 1979;46:143–4.

    CAS  PubMed  Google Scholar 

  • Culp RW, Osterman AL, Davidson RS, Skirven T, Bora Jr FW. Neural injuries associated with supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1990;72(8):1211–5.

    CAS  PubMed  Google Scholar 

  • Dormans JP, Squillante R, Sharf H. Acute neurovascular complications with supracondylar humerus fractures in children. J Hand Surg Am. 1995;20(1):1–4.

    Article  CAS  PubMed  Google Scholar 

  • Ekholm R, Ponzer S, Tornkvist H, Adami J, Tidermark J. The Holstein-Lewis humeral shaft fracture: aspects of radial nerve injury, primary treatment, and outcome. J Orthop Trauma. 2008;22(10):693–7.

    Article  PubMed  Google Scholar 

  • Finsterbush A, Husseini N. Infantile cortical hyperostosis with unusual clinical manifestations. Clin Orthop Relat Res. 1979;144:276–9.

    PubMed  Google Scholar 

  • Flynn JC, Matthews JG, Benoit RL. Blind Pinning of Supracondylar Fractures of the Humerus in Children. J Bone Joint Surg (AM) 1974; 56:263–272.

    CAS  Google Scholar 

  • Galbraith KA, McCullough CJ. Acute nerve injury as a complication of closed fractures or dislocations of the elbow. Injury. 1979;11:159–64.

    Article  CAS  PubMed  Google Scholar 

  • Gaur SC, Swarup A. Radial nerve palsy caused by injections. J Hand Surg Br. 1996;21:338–40.

    Article  CAS  PubMed  Google Scholar 

  • Gosens T, Bongers KJ. Neurovascular complications and functional outcome in displaced supracondylar fractures of the humerus in children. Injury. 2003;34(4):267–73.

    Article  PubMed  Google Scholar 

  • Hayman M, Roland EH, Hill A. Newborn radial nerve palsy: report of four cases and review of published reports. Pediatr Neurol. 1999;21(3):648–51.

    Article  CAS  PubMed  Google Scholar 

  • Holst-Nielsen F, Jensen V. Tardy posterior interosseous nerve palsy as a result of an unreduced radial head dislocation in Monteggia fractures: a report of two cases. J Hand Surg Am. 1984;9:572–5.

    Article  CAS  PubMed  Google Scholar 

  • Hosalkar HS, Matzon JL, Chang B. Nerve palsies related to pediatric upper extremity fractures. Hand Clin. 2006;22(1):87–98.

    Article  PubMed  Google Scholar 

  • Ingari JV, Green DP. Radial nerve palsy. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2010. p. 1075–92.

    Google Scholar 

  • Isaac S, Athanasou NA, Pike M, Burge PD. Radial nerve palsy owing to localized hypertrophic neuropathy (intraneural perineurioma) in early childhood. J Child Neurol. 2004;19(1):71–5.

    Article  PubMed  Google Scholar 

  • Jessing P. Monteggia lesions and their complicating nerve damage. Acta Orthop Scand. 1975;46(4):601–9.

    Article  CAS  PubMed  Google Scholar 

  • Kallio PK, Vastamaki M, Solonen KA. The results of secondary microsurgical repair of radial nerve in 33 patients. J Hand Surg Am. 1993;18(3):320–2.

    Article  CAS  Google Scholar 

  • Krusche-Mandl I, Aldrian S, Kottstorfer J, Seis A, Thalhammer G, Egkher A. Crossed pinning in paediatric supracondylar humerus fractures: a retrospective cohort analysis. Int Orthop. 2012;36(9):1893–8.

    Article  PubMed Central  PubMed  Google Scholar 

  • Lapid O, Ho ES, Goia C, Clarke HM. Evaluation of the sensory deficit after sural nerve harvesting in pediatric patients. Plast Reconstr Surg. 2007;119(2):670–4.

    Article  Google Scholar 

  • Larsen LB, Barfred T. Radial nerve palsy after simple fracture of the humerus. Scand J Plast Reconstr Surg Hand Surg. 2000;34(4):363–6.

    Article  CAS  PubMed  Google Scholar 

  • Lee FY, Schoeb JS, Yu J, Christiansen BD, Dick HM. Operative lengthening of the humerus: indications, benefits, and complications. J Pediatr Orthop. 2005;25(5):613–6.

    Article  PubMed  Google Scholar 

  • Lee YH, Chung MS, Gong HS, Chung JY, Park JH, Baek GH. Sural nerve autografts for high radial nerve injury with nine centimeter or greater defects. J Hand Surg Am. 2008;33(1):83–6.

    Article  PubMed  Google Scholar 

  • Lejman T, Strong M, Michno P. Radial-nerve palsy associated with septic shoulder in neonates. J Pediatr Orthop. 1995;15:169–71.

    Article  CAS  PubMed  Google Scholar 

  • Louahem DM, Nebunescu A, Canavese F, Dimeglio A. Neurovascular complications and severe displacement in supracondylar humerus fractures in children: defensive or offensive strategy? J Pediatr Orthop B. 2006;15(1):51–7.

    Article  PubMed  Google Scholar 

  • Lundy CT. Commentary: radial nerve palsy in the newborn. CMAJ. 2011;183(12):1348–9.

    Article  PubMed Central  PubMed  Google Scholar 

  • Lundy CT, Goyal S, Lee S, Hedderly T. Bilateral radial nerve palsy in a newborn. Neurology. 2009;72(6):576.

    Article  PubMed  Google Scholar 

  • Mackinnon SE, Roque B, Tung TH. Median to radial nerve transfer for treatment of radial nerve palsy: case report. J Neurosurg. 2007;107:666–71.

    Article  PubMed  Google Scholar 

  • Marcu DM, Balts J, McCarthy JJ, Kozin SH, Noonan KJ. Iatrogenic radial nerve injury with cannulated fixation of medial epicondyle fractures in the pediatric humerus: a report of 2 cases. J Pediatr Orthop. 2011;31(2):e13–6.

    Article  PubMed  Google Scholar 

  • McDonnell DP, Wilson JC. Fracture of the lower end of the humerus in children. J Bone Joint Surg Am. 1948;30:347–58.

    Google Scholar 

  • Moore TM, Klein JP, Patzakis MJ, Harvey JP. Results of compression-plating of closed Galeazzi fractures. J Bone Joint Surg Am. 1985;67(7):1015–21.

    CAS  PubMed  Google Scholar 

  • Morgan L. Radial nerve paralysis in the newborn. Arch Dis Child. 1948;23(114):137–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Morris AH. Irreducible Monteggia lesion with radial-nerve entrapment: a case report. J Bone Joint Surg Am. 1974;56(8):1744–6.

    CAS  PubMed  Google Scholar 

  • Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma. 1998;45(1):116–22.

    Article  CAS  PubMed  Google Scholar 

  • Ogawa K, Yoshida A. Throwing fracture of the humeral shaft: an analysis of 90 patients. Am J Sports Med. 1998;26(2):242–6.

    CAS  PubMed  Google Scholar 

  • Ogawa BK, Kay RM, Choi PD, Stevanovic MV. Complete division of the radial nerve associated with a closed fracture of the humeral shaft in a child. J Bone Joint Surg Br. 2007;89(6):821–4.

    Article  CAS  PubMed  Google Scholar 

  • Omer GE. Injuries to nerves of the upper extremity. J Bone Joint Surg Am. 1974;56(8):1615–24.

    PubMed  Google Scholar 

  • Osamura N, Ikeda K, Hagiwara N, Tomita K. Posterior interosseous nerve injury complicating ulnar osteotomy for a missed Monteggia fracture. Scand J Plast Reconstr Surg Hand Surg. 2004;38(6):376–8.

    Article  PubMed  Google Scholar 

  • Pandian JD, Bose S, Daniel V, Singh Y, Abraham AP. Nerve injuries following intramuscular injections: a clinical and neurophysiological study from northwest India. J Peripher Nerv Syst. 2006;11(2):165–71.

    Article  PubMed  Google Scholar 

  • Ray WZ, Mackinnon SE. Clinical outcomes following median to radial nerve transfers. J Hand Surg Am. 2011;36(2):201–8.

    Article  PubMed Central  PubMed  Google Scholar 

  • Regan PJ, Roberts JO, Bailey BN. Acute posterior interosseous nerve palsy caused by bleeding from an arteriovenous malformation. J Hand Surg Am. 1991;16(2):272–3.

    Article  CAS  PubMed  Google Scholar 

  • Royce RO, Dutkowsky JP, Kasser JR, Rand FR. Neurologic complications after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop. 1991;11(2):191–4.

    Article  CAS  PubMed  Google Scholar 

  • Ruchelsman DE, Pasqualetto M, Price AE, Grossman JAI. Persistent posterior interosseous nerve palsy associated with a chronic type I Monteggia fracture-dislocation in a child: a case report and review of the literature. Hand. 2009;4(2):167–72.

    Article  PubMed Central  PubMed  Google Scholar 

  • Sairyo K, Henmi T, Kanematsu Y, Nakano S, Kajikawa T. Radial nerve palsy associated with slightly angulated pediatric supracondylar humerus fracture. J Orthop Trauma. 1997;11(3):227–9.

    Article  CAS  PubMed  Google Scholar 

  • Seckel BR, Ryan SE, Simons JE, Gagne RG, Watkins Jr E. Vascularized versus nonvascularized nerve grafts: an experimental structural comparison. Plast Reconstr Surg. 1986;78(2):211–20.

    Article  CAS  PubMed  Google Scholar 

  • Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fracture of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. 2005;87-B:1647–52.

    Article  Google Scholar 

  • Shergill G, Bonney G, Munshi P, Birch R. The radial and posterior interosseous nerves. Results for 260 repairs. J Bone Joint Surg Br. 2001;83(5):646–9.

    Article  CAS  PubMed  Google Scholar 

  • Singh R, Mechelse K, Hop WC, Braakman R. Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique. Surg Neurol. 1992;37:425–31.

    Article  CAS  PubMed  Google Scholar 

  • Slutsky DJ. A practical approach to nerve grafting in the upper extremity. Atlas Hand Clin. 2005;10:73–92.

    Article  Google Scholar 

  • Smith FM, Joyce III JJ. Fracture of lateral condyle of humerus in children. Am J Surg. 1954;87:324–9.

    Article  CAS  PubMed  Google Scholar 

  • Spinner M, Freundlich BD, Teicher J. Teicher J. Posterior interosseous nerve palsy as a complication of Monteggia fractures in children. Clin Orthop. 1968;58:141–5.

    Article  CAS  PubMed  Google Scholar 

  • Staniforth P, Fisher TR. The effects of sural nerve excision in autogenous nerve grafting. Hand. 1978;10(2):187–90.

    Article  CAS  PubMed  Google Scholar 

  • Stein F, Grabias SL, Deffer PA. Nerve injuries complicating Monteggia lesions. J Bone Joint Surg Am. 1971;53-A:1432–6.

    Google Scholar 

  • Szekeres M. Tenodesis extension splinting for radial nerve palsy. Tech Hand Up Extrem Surg. 2006;10(3):162–5.

    Article  PubMed  Google Scholar 

  • Tollner U, Bechinger D, Pohlandt F. Radial nerve palsy in a premature infant following long-term measurement of blood pressure. J Pediatr. 1980;96:921–2.

    Article  CAS  PubMed  Google Scholar 

  • Tomaszewski R, Gap A, Wozowicz A, Wysocka P. Analysis of early vascular and neurological complications of supracondylar humerus fractures in children. Pol Orthop Traumatol. 2012;77:101–4.

    PubMed  Google Scholar 

  • Tubbs RS, Griessenauer C, Rizk E, Shoja MM, Pehler SF, Wellons JC, Conklin MJ. Posterior interosseous nerve palsy in a child associated with recurrent dislocation of the head of the radius. J Nuerosurg Pediatrics, 2013; 11:389–391.

    Google Scholar 

  • Uchida Y, Sugioka Y. Peripheral nerve palsy associated with congenital constriction band syndrome. J Hand Surg Br. 1991;16(1):109–12.

    Article  CAS  PubMed  Google Scholar 

  • Wang MN, Chang WN. Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision. J Orthop Trauma. 2006;20:1–5.

    Article  PubMed  Google Scholar 

  • Wang D, Liu XL, Zhu JK, et al. Repairing large radial nerve defects by acellular nerve allografts seeded with autologous bone marrow stromal cells in a monkey model. J Neurotrauma. 2010;27(10):1935–43.

    Article  PubMed  Google Scholar 

  • Waters PM, Bae DS. Traumatic peripheral nerve injuries; chapter 37. In: Waters PM, Bae DS, editors. Pediatric hand and upper limb surgery: a practical guide. Philadelphia: Lippincott, Williams, and Wilkins; 2012. p. 462–77.

    Google Scholar 

  • Weinzweig N, Barr A. Radial, ulnar, and median nerve palsies caused by a congenital constriction band of the arm: single-stage correction. Plast Reconstr Surg. 1994;94(6):872–6.

    Article  CAS  PubMed  Google Scholar 

  • Wiley JJ, Galey JP. Monteggia injuries in children. J Bone Joint Surg Br. 1985;67-B(5):728–31.

    Google Scholar 

  • Wilson JN. Fracture of the external condyle of the humerus in children. Br J Surg. 1936;18:299–316.

    Google Scholar 

  • Yang CB, Huang SC. Humeral lengthening using the Ilizarov technique. J Formos Med Assoc. 1997;96(4):291–4.

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Rochester Medical Center, 14642, Rochester, NY, USA

    Anjan P. Kaushik & Warren C. Hammert

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  1. Anjan P. Kaushik
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  2. Warren C. Hammert
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Correspondence to Warren C. Hammert .

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Editors and Affiliations

  1. Dept. of Orthopedics, University of Maryland School of Medicine, Baltimore, Maryland, USA

    Joshua M. Abzug

  2. Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA

    Scott H. Kozin

  3. Shriners Hospitals for Children, Philadelphia, Pennsylvania, USA

    Dan A. Zlotolow

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Kaushik, A.P., Hammert, W.C. (2015). Radial Nerve Injury. In: Abzug, J., Kozin, S., Zlotolow, D. (eds) The Pediatric Upper Extremity. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8515-5_26

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