nerve injuries pre-webinar cases

These cases are are to get you to start thinking and questioning your knowledge ahead of the webinar on nerve injuries: an essential guide for orthopods.

We are joined for this 360 degree educational event by:

Let’s get straight into the cases:

Case 1 - supracondylar with a tingly feeling - Tom Quick

7 year old admitted with a Gartland 3 displaced supracondylar fracture.
No pre-op neurological deficit.
Taken to theatre overnight

Post op

Seen on WR next morning
New onset inability to flex index finger and thumb
Tingling radial 3 digits
Pink but pulseless

Would you...

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Case 2 - humeral shaft fracture with wrist drop - Cy Ng

A 30-year-old right hand dominant musician fell down the stairs and sustained a closed distal humeral shaft fracture associated with a wrist drop.

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Webinar

Please post your thoughts about these cases in the comments section below.

For the answers to these questions and much more join our webinar, Wednesday 20th January at 8pm GMT, or watch back after the event on the above link.

3 Comments

Ahmed Fawzy Ghanem says:

January 19, 2021 at 7:54 pm

Accordingly to the case of supracodylar fracture, if no pulse after change position with pink limb, spo2 99%, should wait for 24 hours or immediately taken child back to theatre
The 2nd case it is better to suture the nerve, epineural suture,Which will lead to less length needed for graft later if needed
1. orthohub says:
  
  January 19, 2021 at 8:38 pm
  
  Hi Ahmed, join us live on the webinar to join the conversation on this and ask the panel.
  I think the message is if there is a new nerve injury would you (or someone with appropriate skills) explore the nerve and vessel as it is likely to either be compressed, caught in the reduction, or by the fixation. The answer is yes.
  I think if you have the skillset to perform a nerve repair this is best, if not ask someone who can... but this will be addressed in the webinar and takeaway videos.
  Mike
Stuart Matthews says:

January 20, 2021 at 3:54 pm

In the case of suspected nerve injury I would not wait at all. I would immediately involve a plastic surgeon as the best results are obtained by immediate repair and with regards to the supracondylar in the child, the reduction is poor and I would revise it and that would be easier to do at an open procedure whilst the nerve is being explored. If the nerve is intact then all is well but if not, delay is associated with a poorer preognosis.