Peripheral nerve palsies in victims of the Hanshin-Awaji earthquake.

On January 17, 1995, the Hanshin-Awaji earthquake directly hit a metropolis and destroyed approximately 120,000 houses. Many people were buried under the debris of the Japanese style wooden houses or were injured by falling furniture. Twenty-five patients (35 extremities) with earthquake associated peripheral nerve palsy were studied and followed up for 2 years. The characteristic feature of earthquake associated palsies was combined nerve palsy induced by prolonged compression. There were 11 extremities with brachial plexus palsy; two extremities with combined radial, median, and ulnar nerve palsy; two extremities with combined median and ulnar nerve palsy; two extremities with radial nerve palsy; two extremities with ulnar nerve palsy; 10 extremities with combined femoral and sciatic nerve palsy; one extremity with combined tibial and peroneal nerve palsy; and five extremities with compartment syndrome of the leg. Many peripheral nerve palsies were induced by nerve ischemia. Most patients had good spontaneous recovery. The prognosis of these palsies generally was good.     

Temporoparietal fascial free flap for correction of first web space atrophy

Fourteen temporoparietal fascial free flaps were used for correction of first web space atrophy from ulnar nerve palsy in 13 patients. Ten sustained ulnar nerve injuries and three suffered from leprosy. The procedures were performed under general anesthesia except one leprosy patient with bilateral ulnar nerve palsy in which local anesthesia and brachial block were employed to harvest bilateral free flaps and recipient site preparations, respectively. The follow‐up time varied from 4 to 64 months. The postoperative results were satisfactory and there was no resorption of the free flaps. The consistency of the augmented first web space was soft and compressible like natural feel. The size of the flap was more than enough for augmentation of first web space and donor site morbidity was minimal and accepted by all patients. We conclude that temporoparietal fascial free flap is an ideal autogenous tissue for correction of first web space atrophy. © 2009 Wiley‐Liss, Inc. Microsurgery 2010.     

Bilateral peroneal nerve injuries in a patient with bilateral femur fractures: a case report

The second reported case in the current literature of peroneal nerve palsy in bilateral femur fractures is described. This is the first case report of bilateral nerve palsies occurring in bilateral femoral fractures and the first report of bilateral peroneal nerve palsy associated with bilateral skeletal traction.     

Tardy ulnar nerve palsy after fracture non-union medial epicondyle of humerus – An unusual case

Tardy ulnar nerve palsy is a chronic clinical condition characterised by delayed onset ulnar neuropathy. Typically tardy ulnar nerve palsy occurs as a consequence of non-union of lateral condyle in child resulting in cubitus valgus deformity which ultimately is the cause of ulnar nerve palsy. However very few literature are available for tardy ulnar nerve palsy as a result of old fracture of medial epicondyle without cubitus varus or valgus deformity. We report a rare case of tardy ulnar nerve in an adult male with fracture non-union of medial epicondyle of humerus.     

儿童肱骨内上髁骨折术后迟发性尺神经炎的预防

目的探讨骨折切开复位内固定并一期行尺神经前移术对肱骨内上髁骨折术后发生迟发性尺神经炎的预防作用。方法将57例眩骨内上髁骨折患者分为骨折切开复位内固定并一期行尺神经前移（32例）和单纯骨折切开复位内固定（25例）两组,对两组迟发性尺神经炎的发生率进行比较．结果骨折切开复位内固定并一期行尺神经前移组的迟发性尺神经炎发生率为6．25％,而单纯骨折切开复位内固定组为36％．两组差异有显著性（P〈0．05）。结论 肱骨内上髁骨折切开复位内同定并一期行尺神经前移能较好地预防术后迟发性尺神经炎的发生。     

Ulnar nerve palsy at the elbow after surgical treatment for fractures of the olecranon

Despite close proximity of the fracture site to the nerve, ulnar nerve palsy after surgery for fracture of the olecranon is uncommon. We examined 18 cases of fracture of the olecranon treated surgically retrospectively to see if there were any characteristics common to 4 cases of ulnar nerve palsy. Three cases of palsy with a comminuted fracture had fair or poor reduction as revealed by both the lateral and anteroposterior radiographs taken at the time of surgery. The other case, with little displacement of the fragment, had osteoarthritic changes at the medial side of the elbow. The mechanism of development of ulnar nerve palsy is considered to be multifactorial. However, it should be noted that evaluation of reduction of the fracture, not only on a lateral radiograph but also on an anteroposterior radiograph at the time of surgery, is important to prevent the ulnar nerve from being jeopardized.     

Post-traumatic bilateral facial palsy: a case report and literature review

Bilateral facial paralysis due to basilar skull fracture involving the temporal bone is rare and, unlike unilateral facial palsy, it can be difficult to recognize because of a lack of facial asymmetry. Thorough clinical history and physical exam, high-resolution CT scan and electrodiagnostic tests can help to make the diagnosis of bilateral facial nerve palsy and early detection, evaluation and intervention may be important for optimal functional recovery. A 16-year-old male sustained closed head injury after motor vehicle collision. The initial head CT scan showed bilateral temporal bone fractures. On admission to the neurotrauma intensive care unit, his Glasgow Coma Score was 9T. On post-injury day 4, the patient was noted to have incomplete closure of both eyes and 3 days later he had difficulty with bilateral facial muscle movement during a feeding trial. Electrodiagnostic testing confirmed the diagnosis of bilateral facial nerve injury without evidence of significant distal axonal degeneration. A high-resolution CT scan showed bilateral temporal bone fractures without involvement of the fallopian canals. There was no surgical intervention based on the high-resolution CT scan and the delayed onset of facial palsy. A short course of prednisone was administered. By 10 months, the patient showed nearly complete recovery of his bilateral facial nerve function. Early detection, evaluation and intervention are important for optimal functional recovery after facial nerve injury. When the temporal bone is fractured, high suspicion for facial nerve injury, either unilateral or bilateral, is warranted.     

Traumatic bilateral hip dislocation with bilateral sciatic nerve palsy

Bilateral hip dislocation rarely occurs. In this paper, a case of bilateral hip dislocation associated with bilateral sciatic nerve palsy resulted from a road traffic accident is reported. Both hips were emergently reduced under general anaesthesia. Acetabular reconstruction was done bilaterally due to the unstable hips. The patient subsequently developed heterotopic ossification and avascular necrosis on the left hip and underwent total hip arthroplasty. The sciatic nerve on the right side achieved complete recovery but that on the left side only partly recovered and was augmented by tendon transfer. Such injuries are serious and one should be aware of the complications because they can resurface and so patients should be followed up for a long time. To the best of our knowledge, this kind of injury has not been reported in the English .language literature.     

Therapeutic management of postoperatively diagnosed bilateral recurrent laryngeal nerve paralysis

Bilateral vocal cord paralysis is a rare but potentially dangerous postoperative complication in thyroid gland surgery. There is a controversial discussion about therapeutic management of postoperative bilateral vocal cord paralysis. METHODS: We analysed the frequency of bilateral nerve palsy in 985 operations. The disease of thyroid gland, the operative procedure, the exposure of laryngeal nerve, the mobility of vocal cord detected by an otolaryngologist, clinical symptoms and therapy of patients with bilateral paralysis were analysed. All patients were examined immediately postoperatively and 5 days, 14 days, 6 and 12 months after resection. RESULTS: The overall transient bilateral palsy rate was 0.7%, the permanent 0.3%. The palsy rate depended on the disease of thyroid gland. After resection of simple goitre we found a 0.2% transient injury rate (0.1% permanent), after operation of thyroid cancer 2.0% transient (1.0% permanent) and in cases of recurrent goitre 5.9% transient (1.9% permanent) palsies. The immediate postoperative symptoms are also very different. There are patients suffering from stridor and dyspnoea, patients with dysphonia without dyspnoea and those without any symptoms. These different clinical symptoms are due to the different grade of laryngeal nerve damage and the resulting position of vocal cords. The bilateral paralysis was completely temporary in 4 cases. 12 months later 4 patients suffered from dysphonia. Only in 3 patients with thyroid cancer and a preoperative unilateral vocal cord paralysis tracheostomy was necessary after operation. The vocal cord mobility did not recover in these 3 cases after 12 months and the patients are not decannulated. DISCUSSION: Bilateral paralysis is only relevant in thyroid cancer and recurrent goitre. The symptoms varies and no patient should leave the hospital without examination of the vocal cords by an otolaryngologist. Because vocal cord paralysis is temporary in most cases an emergency tracheostomy is seldom indicated.     

Secondary ulnar nerve palsy in adults after elbow trauma: a report of two cases

Secondary ulnar nerve palsy, an unusual condition in which the onset of ulnar nerve dysfunction occurs 1 to 3 months after elbow trauma, can be the cause of sudden deterioration of elbow function. Initially recognized in 1899, this condition has not been reported often. We describe 2 patients who had no subjective or objective evidence of ulnar nerve dysfunction after elbow trauma but had a sudden loss of motion, pain, and clinical and electrophysiologic evidence of ulnar nerve compression at the elbow 4 to 5 weeks after trauma. Marked improvement occurred after ulnar nerve subcutaneous transposition and contracture release.     

Ulnar nerve palsy associated with fracture of the distal radius

OBJECTIVE: To describe the clinical features and outcome of a series of patients with complete motor and sensory ulnar nerve palsy associated with a fracture of the distal radius. DESIGN: Retrospective case series. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: Five adults with acute complete motor and sensory ulnar nerve palsy associated with fracture of the distal radius were treated during a 2 year period. There were 3 men and 2 women, with an average age of 42 years (range, 33 to 56 years). All 5 distal radius fractures were high energy and widely displaced. Three patients had an associated ulna fracture (2 styloid, 1 styloid and distal diaphysis), and 1 had a complete triangular fibrocartilage complex (TFCC) avulsion from the distal ulna (associated with an open wound). Two patients had open fractures. INTERVENTION: Open reduction and internal fixation of the distal radius fracture in 4 patients and external fixation in 1 patient. Three patients had exploration and release of the ulnar nerve because it was associated with an acute carpal tunnel syndrome. MAIN OUTCOME MEASUREMENTS: Recovery of ulnar nerve function. RESULTS: At an average follow-up of 17 months, 4 patients had complete or near-complete recovery of ulnar nerve function. One patient had moderate motor and mild sensory dysfunction. CONCLUSIONS: Acute ulnar nerve palsy may occur in association with high-energy, widely displaced fractures of the distal radius. These are usually neurapraxic injuries that recover to normal or near-normal strength and sensation. We recommend exploration and release of a complete ulnar nerve palsy associated with a fracture of the distal radius fracture when there is an open wound or an acute carpal tunnel syndrome, and observation without exploration otherwise.     

Delayed ulnar nerve palsy secondary to ulnar artery pseudoaneurysm distal to Guyon’s canal following penetrating trauma to the hand

Compression of the ulnar nerve in Guyon’s canal is an uncommon phenomenon. Reports of ulnar nerve palsy secondary to ulnar artery pseudoaneurysm at this anatomical location are very rare and equivalent pathology just distal to this site is unheard of. Here we present such a case, which featured a delayed onset of symptoms. This followed penetrating trauma to the hand. Our methods for diagnosis, operative planning and surgical treatment are included.     

Congenital constriction band syndrome causing ulnar nerve palsy: early diagnosis and surgical release with long-term follow-up.

Three children with congenital constriction band syndrome affecting their upper extremities demonstrated clinical and electrophysiologic signs of a complete ulnar nerve palsy. Two of the children were diagnosed immediately postpartum with the subtle findings of an intrinsic minus posture of their hand and inability to actively extend their fingers at the proximal interphalangeal joints. One child had at least 5.5 months of intrauterine compression of the ulnar nerve detected by ultrasound examination at 18 weeks. Despite early release of the constriction bands, at 3 months in 2 children and at 6 months in 1 child, the ulnar nerve palsies persisted for a mean follow-up period of 7 years. If clinical examination of an infant with constriction band syndrome is indicative of a complete ulnar nerve palsy, the constriction band should be released as early as possible. If surgical exploration reveals significant compression of the ulnar nerve, consideration should be given to excising the involved segment of nerve with immediate primary nerve repair or nerve grafting because even early release of the constriction band does not seem to result in neurologic improvement in long-term follow-up studies.     

Tardy ulnar nerve palsy caused by cubitus varus deformity

Clinical features and X-rays of thirty-four cases with cubitus varus deformity were analysed in order to explain the occurrence of tardy ulnar nerve palsy caused by cubitus varus deformity. Cubitus varus cases with tardy ulnar nerve palsy, compared to cases without it, were older at the first visit to the clinic for cubitus varus deformity. There were no other differences between the two groups in clinical features. Computed tomography showed that the olecranon moved to the ulnar side against the olecranon fossa. Operative findings showed that the medial head of triceps brachii shifted medially and covered the ulnar nerve. Both from computed tomography and operative findings we conjectured the possibility that tardy ulnar nerve palsy was caused because the ulnar nerve was compressed by the forward medial movement of the medial head of the triceps brachii caused by cubitus varus deformity.     

Prevention of ulnar nerve injury during fixation of supracondylar fractures in children by 'flexion-extension cross-pinning' technique

No consensus exists concerning the best pin configuration for displaced supracondylar fractures of the humerus in children. Although cross-pinning is the most stable biomechanically, this configuration may cause iatrogenic ulnar nerve palsy. For the last 7 years, we have been using a three-pin fixation technique with insertion of two K wires from the lateral side (elbow in full flexion) and the third wire through the medial side (elbow in full extension). We used this technique in 67 displaced supracondylar fractures without any complications related to the ulnar nerve. The technique provides excellent stability and eliminates the risk of iatrogenic ulnar nerve palsy.     

Bilateral temporoparietal fascial free flaps for reconstruction of bilateral hand defects: A report of two cases

Bilateral temporoparietal fascial free flaps were used for reconstruction of bilateral hand defects in two male patients. A 42‐year‐old man sustained crushed injury to both hands with avulsion defects and exposed bones and tendons. The two separate procedures were performed under general anesthesia. The temporoparietal fascial free flap was skin grafted on the ward on the following day after the operation. The other patient was a 61‐year‐old leprosy patient who had bilateral high ulnar nerve palsy for 28 years. One simultaneous procedure was performed under local anesthesia for harvesting the temporoparietal fascial free flaps and under brachial block for preparation of the recipient sites. The free flaps were used for augmentation of the atrophic first web spaces. The postoperative results of the two cases were satisfactory. The functions of both hands were restored with normal gliding mechanism of the tendons in the first case, and permanent correction of the atrophic web spaces was demonstrated in the second case. The temporoparietal fascial free flap is an ideal flap for coverage of hand defects as well as augmentation of first web space atrophy. © 2009 Wiley‐Liss, Inc. Microsurgery 2009.     

Endoscopic Anterior Transposition of Ulnar Nerve (EATUN) for Treatment of Tardy Ulnar Nerve Palsy

BackgroundTardy ulnar nerve palsy is the development of late onset ulnar nerve dysfunction and is usually treated by open anterior transposition of ulnar nerve. Open technique is done using a longitudinal incision about 6–8 inch. in length with chances of development of medial antebrachial cutaneous nerve neuromas.PurposeIn this study, we describe the technique of Endoscopic Anterior Transposition of Ulnar Nerve (EATUN procedure) to treat tardy ulnar nerve palsy and analyze the results.MethodsSeven patients diagnosed to have tardy ulnar nerve palsy was treated by EATUN. The humerus-elbow-wrist angle (HEW), pre- and post-operative intrinsic muscle power and sensory assessment, Dellon scores, and the Q-DASH was analyzed.ResultsThe minimum follow-up was 12 months (Mean 27.4 months, Range 12–36 months). Improvement in Dellon and Q-DASH scores following EATUN procedure was statistically significant. There was objective improvement of intrinsic muscle power and sensation on follow-up, though not statistically significant. No instance of neuroma of the medial cutaneous nerve of forearm was noted.ConclusionsThe endoscopic anterior transposition of the ulnar nerve is a good option in surgical management of tardy ulnar nerve palsy.Level of evidenceTherapeutic Level IV.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43465-021-00366-w.     

Ulnar intrinsic anatomy and dysfunction.

Normal hand function is a balance between the extrinsic and intrinsic musculature. Although individually the intrinsics are small muscles in diameter, collectively they represent a large muscle that contributes approximately 50% of grip strength. Dysfunction of the intrinsics consequently leads to impaired grip and pinch strength as well recognized deformities. Low ulnar nerve palsy preserves ulnar innervated extrinsics resulting in sensory loss, digital clawing, thumb deformity, abduction of the small finger, and asynchronous finger motion. High ulnar nerve palsy is characterized by the above plus paralysis of the ulnar profundi and the flexor carpi ulnaris. Understanding the normal anatomy allows the clinician to identify the site of the lesion and plan appropriate surgical intervention. This article revisits the classic work of Richard J. Smith on ulnar nerve palsy with contemporary perspective.     

Nonunion of a pediatric lateral condyle fracture without ulnar nerve palsy: sixty-year follow-up.

Displaced lateral condyle fractures in the pediatric population are usually treated with open reduction and internal fixation. Significant complications associated with the nonoperative management include nonunion, malunion, deformity, and tardy ulnar nerve palsy. However, few cases of nonunion of the lateral condyle and tardy ulnar nerve palsy with long-term follow-up have been reported. We present a radiographically documented case of a pediatric lateral condyle fracture and subsequent nonunion with significant cubitus valgus deformity without ulnar nerve palsy sixty years following injury.     

Proximal ulnar nerve compression secondary to tophaceous gout

Although gout is a recognised but rare cause of carpal tunnel syndrome, compression of the ulnar nerve by tophaceous gout is rare. We describe a case of proximal ulnar nerve compression due to tophaceous gout in an 87-year-old man. Surgical decompression, with excision of the lesion and a section of the ulnar belly of Flexor Carpi Ulnaris produced symptomatic relief. This case illustrates that in the differential diagnosis of ulnar nerve palsy, tophaceous gout should be considered in those patients with known gout.