Diagnosis and Management of Nerve Injuries Caused by Pediatric Upper Extremity Fractures Current Concept Review

Abstract

Although nerve injuries occur commonly with pediatric upper extremity fractures, there is very little existing literature to guide management of those nerve injuries that do not recover during routine fracture healing and follow-up, and even less guidance is available regarding the choice of diagnostic tests such as magnetic resonance imaging (MRI) with nerve sequences, electromyography (EMG), nerve conduction velocities, (NCV), ultrasound (US), or other modalities. In addition, patterns of nerve injury and timing of nerve recovery differ amongst different fractures.  This review article describes the nerve injuries and specific details of humeral shaft, supracondylar, Monteggia fracture-dislocations,  and forearm fractures as well as the various available diagnostic tests in an attempt to synthesize the available literature, of which most is in the adult population, as well as the extensive clinical experience of the authors, all of whom specialize in pediatric hand and upper extremity.