Disclosures: Jinpu Li, MD: Nothing to disclose

Case Description: 6-year-old, right handed girl, presented for left hand weak grip and hypoesthesia after a fall 8 weeks prior when she had left humerus supracondylar fracture and elbow dislocation. S/P ORIF with pins, which were removed at 3-4 weeks post operation. Exams showed significant left thenar and hypothenar atrophy, all metacarpophalangeal joints in extension posture, left elbow in valgus deformity, and weakness of fingers and wrist flexion. She could not make a fist or abduct/adduct the fingers and had decreased sensation to light touch on volar surface of entire hand.

Setting: tertiary referring center.

Patient: 6-year-old girl

Assessment/Results: Electrodiagnostic study showed left median and ulnar nerves motor and sensory neuropathy with severe axonal loss. Patient started on OT with figure 8 splint around metacarpophalangeal joints to position them flexed and allow active interphalangeal joints extension and flexion, along with strengthening exercise twice a week. After 3 months of therapy, she regained the strength and sensation completely.

Discussion: Humerus supracondylar fracture is the most common elbow fracture in children. Multiple neurological structures cross the elbow, and thus are at risk of injuries. The associated nerve injury incidence was reported to be 11.3%, with the anterior interosseous having the highest rate (4.6%), followed by radial nerve (4.1%), median nerve (3.0%) and ulnar nerve (2.6%). Multiple neuropraxia counts for 1.7%. The mechanism of injury is by compressing, stretching or transecting the nerve due to direct trauma and iatrogenic factors. Percutaneous pin fixation increases the risk of nerve injuries. The majority of neurological injuries are neuropraxias, and recovery is typically seen within 6-16 weeks. Splinting, stretching and strengthening exercise are essential to improve the hand functions and to prevent atrophy and contracture.

Conclusion: Concurrent median and ulnar injury in humerus supracondylar fracture is uncommon. Although it can present as severe axonal neuropathy, excellent recovery is possible with appropriate therapy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/hand-muscle-atrophy-after-humerus-supracondylar-fracture-a-case-report/