A MULTI-SEGMENTAL NERVES INJURY REPAIR ASSOCIATED WITH OPEN SEGMENTAL HUMERUS FRACTURE: A LONG-TERM FOLLOW-UP

English

Abstract

Introduction: Peripheral nerve injuries associated with a fracture are common insults that frequently cause permanent disability. A perfect treatment approach is needed to have the best long-term outcome.

Case presentation: A 10-year-old boy with a wound on the left upper limb suffered for 6 hours before admitted to Hospital. On examination, there was a segmental rupture of the median nerve, total rupture of the ulnar and radial nerve, segmental fracture humerus, total rupture of the biceps muscle, and complete rupture of the brachialis and brachioradialis muscle. We performed debridement, ORIF plate and screws for the bone and primary end to end repair for ulnar and radial nerves with epineural neurorrhaphy; sutured the segment of the median nerve; then sutured the brachialis muscle, brachioradialis muscle and bicep muscle. After 2 years from the surgery, the patient regained his full daily activity function without pain and no infection. 

Discussion: Characteristics of the fracture, contamination of the wound, and appropriate reduction technique are significant predictors of segmental fracture healing. With proper debridement, reduction, and neurorrhaphy, the patient achieved callus formation three weeks after the surgery and regained its full daily activity function after two years of follow-up.  

Conclusion: Segmental fracture with multi-segmental nerve injury can provide good functional outcomes for daily activities followed by treated properly, appropriately and adherent rehabilitation.

Keywords: Nerve repair, multi-segmental injury, peripheral nerve, primary repair, segmental fracture