P127. Nerve ultrasound in children with ulnar neuropathy associated with supracondylar humerus fracture

Publication date: August 2018

Source: Clinical Neurophysiology, Volume 129, Issue 8

Author(s): A.K. Peyer Kauffmann, S. Mittas, A. Schiller, K. Otten, T. Schmitt-Mechelke, M. Calcagni, E. Wilder-Smith

Background

Assessing nerve traumas in children is challenging. Electrodiagnostic studies are often not tolerated. We tested if ultrasound examination in children with recent supracondylar humerus fracture and ulnar nerve pathology was well tolerated and whether it was helpful in assessing the nerve trauma.

Methods

This is a retrospective analysis of all pediatric cases with recent supracondylar humerus fracture and persistent ulnar deficits presenting to our neurology outpatients clinic from October 2016 to September 2017. All patients underwent clinical neurological examination. Additional examinations in the form of EMG and nerve ultrasound using a 18 MHz hockey stick probe were proposed as additional investigations.

Results

Patients were aged 3–10 years (mean age 6.3 years), 4 male and 2 female. All experienced severe extension type supracondylar humerus fractures (Type III and Type IV), treated with closed (3 patients) or open reduction (3 patients) and fixed with crossed pinning (2–4 pins). Ulnar nerve deficits in intrinsic hand muscles ranged from M0 to M3. 3 patients showed complete loss of ulnar sensory motor function. 3 were able to tolerate EMG. All 6 patients tolerated and were able to complete ultrasound examination. In 1 patient with complete loss of function, discontinuity of the nerve with formation of stump neuromas was detected in ultrasound. In the other 5 cases, nerve continuity could be demonstrated, but significant nerve swelling (sulcus to upper arm ratios 1.4–2.7; mean 1.97) was apparent in all. In the 2 most severe cases of nerve swelling, additional nerve compromise with scar tissue was detected. Ultrasound findings led to surgical intervention in 2 cases (in one additional EMG data was available): 1) nerve repair by a sural nerve graft for the case of neuronotmesis and 2) neurolysis followed by anterior displacement in one case with severe nerve swelling and compromising scar tissue.

Conclusions

Nerve ultrasound is well tolerated in children and proved to be useful and informative for management and counselling. Useful ultrasound indicators of neuronal damage included loss of nerve continuity, neuroma formation, compromising scar tissue and nerve swelling.

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