Closed injuries of the median nerve in children: tactics, variants of surgery

Purpose. To demonstrate intraoperative variants of closed injuries of the median nerve, possible types of surgical correction, their correlation with preoperative clinical, electromyographic and ultrasound findings.

Material and methods. 10 children with closed injuries of the median nerve were examined with a score scale, electroneuromyography and ultrasound. The obtained findings were compared with intraoperative findings.

Results. Complete and deep impairments of median nerve conduction were revealed after supra-, trans-condylar fractures of the humerus and dislocation in the elbow joint many weeks and months later after the date of injury. 6 out of 10 children were operated on because of the lack dynamics in neurological symptoms. At the same time, in two cases ultrasound examination showed that the nerve trunk was completely involved in the callus and strangled; this finding corrected surgical tactics. Intraoperatively , three variants of median nerve injury were described: (1) the nerve has an angular deformation, is surrounded by bone or scar tissues, compressed and fixed to the underlying bone or soft tissues without nerve bundles damage; (2) in addition to the abovementioned, the nerve has damaged bundles with various degrees of damage; (3) the nerve is located in scars in its usual position with intact bundles and without a distinct neuroma formation.

Conclusion. Comparison of clinical, edectroneuromyographic and ultrasound findings plus intraoperatively identified variants of nerve damage allows to choose a proper surgical tactics - decompression and neurolysis with restoration of the nerve natural position in tissues, microsurgical partial autoplasty or microsurgical suture of the nerve trunk. Ultrasound examination helps to clarify indications for surgery.