![]() ![]() The sensory examination should be done first to gain the confidence of the child since this is unlikely to provoke pain. Autonomous zones of the nerves should be checked to avoid confusion. The pulp of the index finger should be checked for the median nerve. This assessment should be repeated at regular intervals and is especially important before and after application of a splint.Įvery hospital should have a standardized way of assessment which helps not only improve documentation and practice but also minimizes medicolegal issues should any arise later on. This can sometimes be difficult to perform when children are in pain and quite anxious. Analgesia should be provided and adopting a playful and friendly approach helps during neurovascular assessment. However, new neurologic deficit after surgery may need consideration for exploration to ensure the nerve is not trapped within the fracture site. One must also be careful to protect the ulnar nerve when using medial K-wires. Most neurologic deficits identified at the time of injury are temporary and spontaneously recover within six months. In flexion type fractures, the ulnar nerve is most commonly injured. The median, radial and ulnar nerves are also injured in decreasing frequency. This is proposed to be firstly due to direct contusion of the dorsal part of the median nerve by the proximal fracture fragment where the anterior interosseus nerve (AIN) fascicles lie. Secondly, the AIN has less ability to stretch since it is fixed when it lies on the interosseous membrane in the forearm by multiple fibrous bands. In extension type fractures, which accounts for nearly 98% of all supracondylar fractures, the anterior interosseous nerve is most commonly injured. They are mostly closed injuries and have associated neuropraxia in 11.3% of fractures. They commonly occur between two and ten years of age with equal predilection for boys and girls.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |