Ulnar Nerve Deficit Case Series in Pediatric Midshaft Forearm Fractures: Four Cases with Nerve Entrapment in Callus Tissue

Purpose: Ulnar nerve palsy is a rare condition in children with closed fractures of the forearm. In the present study, we aimed to analyze 4 pediatric cases who underwent closed reduction and casting due to forearm mid-shaft fracture and then underwent surgical treatment for neurological deficit due to ulnar nerve entrapment in callus tissue. Methods: The files of 4 pediatric cases (3 male-1 female) who were diagnosed with forearm double fracture and underwent surgery for ulnar nerve deficit between 2013 and 2020 were reviewed retrospectively. Results: Nerve auto-graft was required in one patient (Case 1) who underwent late exploration, and end-to-end anastomosis was required in one patient (case 2). There was sensory recovery at the 8th week post anastomosis. However the two point discrimination recovery was not full. Partial motor recovery occurred in the 16th week. Pinch and grip strengths and low motor amplitude were still partially defective at 36 weeks. Conclusion: Albeit rare, ulnar nerve injuries associated with mid-shaft forearm fractures of both the radius and ulna exist and can result in debilitating morbidity if not detected in a timely manner. For this reason, early diagnosis and early surgical exploration are important. Routine neurological examination and USG in case of doubt may be beneficial in early diagnosis.