Background: The treatment of closed fractures with associated peripheral nerve palsy is controversial. Traditionally, the nerve palsy is managed with watchful waiting and subsequent neurophysiological studies if no improvement is seen within 4 months. This may not be necessary if nerve integrity can be imaged acutely with ultrasound scan. We present a case series of pediatric patients with closed upper limb injuries and associated peripheral nerve palsy who underwent ultrasound scanning to assess nerve integrity.
Methods: A retrospective review of patients attending Starship Children's Hospital between May 2008 and April 2010 with closed upper limb injuries and associated peripheral nerve palsy was undertaken. Those patients up to and including the age of 14 years (skeletally immature) with complete clinical records available were included.
Results: Complete clinical records were available for 24 patients who fit the inclusion criteria for the period of May 2008 to April 2010. Fifteen patients were managed expectantly and showed signs of spontaneous nerve recovery at a mean of 4 weeks. One patient proceeded to theater for early exploration where an intact but kinked nerve was found. Eight patients underwent ultrasound examination of their nerves; on the basis of the ultrasound findings, 3 proceeded to theater for nerve repair or neurolysis and 5 were managed expectantly with first signs of nerve recovery seen at a mean of 12 weeks for the surgical group, and 13.2 weeks for the nonsurgical group.
Conclusions: Ultrasound examination of peripheral nerves provides pathomorphologic information that can aid our clinical decision-making process and identify those patients who would benefit from early surgical intervention. In our case series, ultrasound findings correlated with intraoperative findings and clinical recovery.
Level of evidence: Level III evidence retrospective comparative study.