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…

proceed conservatively

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Take the child back to theatre immediately

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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.

What is your preferred treatment of the fracture?

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Does the presence of radial nerve palsy influence your preferred choice in question 1?

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If you have opted for conservative management initially, how long would you wait for spontaneous recovery of the radial nerve?

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If you have opted for operative management of the fracture, what is your preferred surgical approach?

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Following an IM nailing, there is no improvement in wrist drop. How long would you wait before considering surgical exploration of the nerve?

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At the time of ORIF with a plate, the radial nerve is explored and is found to be 100% lacerated as a result of the primary injury. Do you:

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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.

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2 Responses

  1. 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

    • 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

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