Radial nerve lesion after medial epicondyle osteosynthesis in a pediatric patient: A rare complication of surgery.

Fractures of the medial epicondyle are relatively common in children and may be associated with nerve lesion, especially in case of displacement. Incarceration of the ulnar nerve in the fracture site is feared in Watson-Jones stage II, rarely directly related to osteosynthesis. Depending on the degree of fracture displacement, various osteosynthesis techniques may be used; nerve injuries are a rare but known complication of these procedures. We report a case of radial nerve injury related to pinning osteosynthesis of a medial epicondyle fracture.

Management of combat-sustained radial nerve injury during World War I: The case of Louis-Ferdinand Céline.

The radial nerve conveys sensory and motor information to and from the upper limb, and radial nerve injury can induce functional disability, as demonstrated by the case of the renowned French writer Louis-Ferdinand Céline (1894-1961), who sustained a gunshot injury to his right arm in October 1914. Radial nerve injuries treated during World War I inspired the publication of several medical handbooks and medical theses, such as that of the military surgeon Major Robert Bretton (1889-1956). The aim of this paper is, via Céline's injury, to explore the management of radial nerve injury during and since World War I. It is important to consider the historical perspective in order to improve radial nerve injury management so as to adapt to modern warfare.

Tendon transfer surgery for radial nerve palsy.

Palliative tendon transfer is an integral part of radial nerve palsy treatment. It can be considered in the first weeks when the possibility of nerve repair by direct suture or nerve grafting is not feasible or reasonable. Mostly, it is discussed secondarily when it is too late for nerve surgery and motor recovery cannot be expected, or after failure or incomplete recovery after nerve repair. The goal of tendon transfers is to restore wrist, finger and thumb extension. For wrist extension, the use of pronator teres is well accepted. The best tendon transfer for finger extension is debated. This can be restored doing a flexor carpi ulnaris (FCU), flexor carpi radialis or flexor digitorum superficialis (FDS) to extensor digitorum communis transfer. Regarding thumb extension and abduction, a palmaris longus (PL) or one FDS tendon to the rerouted extensor pollicis longus (EPL) transfer can be performed. If a transfer is done on the EPL without rerouting it, abduction can be restored by doing a tendon transfer to the abductor pollicis longus (APL) or an APL tenodesis. The different tendon transfer options are selected based on the surgeon's preference, and most importantly, discussed with the patients to define the objectives together. The transfer is chosen based on the clinical examination (high or low radial nerve palsy, tendon available for transfer like PL, wrist mobility) and based on the patient's needs and expectations (activities requiring the FCU, finger independence, independence of thumb extension or abduction). If the surgical rules and the postoperative instructions for rehabilitation are followed, tendon transfers for radial nerve palsy regularly produce very satisfactory results.

[Pseudotumoral calcinosis of the wrist compressing the radial nerve in systemic sclerosis]. / Compression du nerf radial au poignet par une calcinose pseudo-tumorale au cours d'une sclérodermie systémique.

BACKGROUND: Pseudotumoral calcinosis, a rare complication of systemic scleroderma, is characterized by the presence in extra-articular tissue, but rarely intra-articular tissue, of large masses made up of hydroxyapatite crystals. PATIENTS AND METHODS: We report an original case of intra- and extra-articular pseudotumoral calcinosis of the wrist diagnosed in a patient followed for mild systemic scleroderma. The calcinosis was revealed in a highly unusual way via ductal syndrome secondary to compression of the radial nerve in the wrist. Surgical treatment resulted in marked clinical and functional improvement. COMMENT: Although subcutaneous calcinoses are a fairly common complication of systemic scleroderma, the pseudo-tumoral form remains extremely rare. It may be complicated by pain, recurrent infection, and functional restriction, but literature contains only very rare reports of its revelation via ductal syndrome.

High radial nerve palsy.

High radial palsy is primarily associated with humeral shaft fractures, whether primary due to the initial trauma, or secondary to their treatment. The majority will spontaneously recover, therefore early surgical exploration is mainly indicated for open fractures or if ultrasonography shows severe nerve damage. Initial signs of nerve recovery may appear between 2 weeks and 6 months. Otherwise, the decision to explore the nerve is based on the patient's age, clinical examination and electroneuromyography, as well as ultrasonography findings. If recovery does not occur, an autograft is indicated only in younger patients, before 6 months, if local conditions are suitable. Otherwise, nerve transfers performed by an experienced team give satisfactory results and can be offered up to 10 months post-injury. Tendon transfers are the gold standard treatment and the only option available beyond 10 to 12 months. The results are reliable and fast.

Lipofibromatous hamartoma of the radial nerve: An unusual location.

Lipofibromatous hamartoma is a congenital and ineradicable benign tumour of the peripheral nerve sheaths, affecting almost exclusively the median nerve and its branches. It corresponds to an infiltration of the nerve by lipofibramatous tissue that dissociates the fascicles. We report a highly unusual case of a lipofibromatous hamartoma of the radial nerve in the upper extremity in a 52-year-old female patient.

Subcutaneous rupture of the superficial branch of the radial nerve at the wrist. A case report and review of literature.

Isolated neuropathy of the superficial branch of the radial nerve (SBRN) is a rarely recognized pathology. It was initially described by Wartenberg in 1932. Various causes have been published. We report a case of an unusual injury of the SBRN at the wrist, never been previously reported in the literature. A 40-year-old woman presented with pain and paresthesia over the area of the lateral aspect of the wrist, thumb and first web two months after a blunt trauma of the left forearm. After failure of conservative treatment, surgical exploration found a neuroma of one branch of the SBRN. No distal nerve stump was found. Neuroma resection was performed and the nerve was transposed and embedded into the flexor pollicis longus muscle. With a six months follow-up, the result was satisfactory.

[Compression of the superficial branch of the radial nerve by a synovial ganglion of the elbow (about one case and literature review)]. / Compression du rameau superficiel du nerf radial par un kyste synovial du coude (À propos d'un cas et revue de littérature).

Compression of the radial nerve at the elbow is quite rare; entrapment of its superficial branch is exceptional. Extrinsic compression is the most frequent etiology. Magnetic resonance imaging plays a major role in the diagnosis, and early surgical excision or echoguided drainage - in case of synovial ganglion - allows a total recovery. The authors report the case of a compression of the superficial branch of radial nerve by an elbow synovial cyst treated by surgical resection.

Diagnóstico y pronóstico electromiográfico durante la rehabilitación de las lesiones del nervio radial / Diagnosis and electromyographic prognosis during the rehabilitation of the radial nerve injuries / Diagnostic et pronostic électromyographique lors de la restauration des lésions du nerf radial

Se realizó un estudio prospectivo en 14 pacientes con lesión del nervio radial, los cuales fueron estudiados clínica y electromiográficamente durante los primeros 4 meses, con evoluciones a los 6 y 8 meses de tratamiento rehabilitador. Se encontró correlación entre los hallazgos clínicos y los electromiográficos, no así entre el seguimiento clínico y los resultados de la conducción nerviosa. Se obtuvieron mejores resultados en aquellos pacientes que iniciaron el tratamiento precozmente, sobre todo si existió una adecuada cooperación de éstos.

A prospective study of 14 patients with radial nerve injuries was carried out. These injuries were clinical and electromyographically studied during the first 4 months with evolution at the 6th and 8th month of rehabilitative treatment. A correlation was found between the clinical and the electromiographical findings, but not between the clinical follow-up and the results of nerve conduction. Better results were obtained among those patients who began the treatment earlier, mainly when they cooperated adequately.

Une étude prospective chez 14 patients atteints d´une lésion dunerf radial, lesquels ont été cliniquement et électromyographiquement étudiés lors des premiers 4 mois, avec des évolutions aux 6 et 8 mois de traitement restaurateur, a été réalisée. Une corrélation entre les trouvailles cliniques et les électromyographiques a été trouvée, il n´en est pas de même entre le suivi clinique et les résultats du comportement nerveux. Des meilleurs résultats ont été obtenus chez ces patients-là qui ont précocement initié le traitement surtout s´il a existé une coopération adéquate de ceux-ci.