Purpose. The management of nerve injuries in open pediatric forearm fractures remains unclear. The purpose of our study was to describe the relative frequency of nerve injuries with open both bone forearm fractures, as well as rates of nerve recovery after injury and the impact of early surgical nerve exploration.
Methods. We retrospectively reviewed 71 patients with open both bone forearm fractures at a tertiary care children’s facility between January 1, 2005 and October 31, 2019. We reviewed the medical record for the presence and type of motor nerve injury, injury characteristics, timing of intervention, return to the operating room and presence of limitations in function at follow up. Injury characteristics and outcomes were summarized using univariate statistics.
Results. Ten patients (14%) sustained a concomitant motor nerve injury. Postoperatively, 7 patients demonstrated no limitation in function and complete nerve recovery at a median time of 8 weeks (range: 1-28) after injury. Two patients had persistent nerve deficits at final follow up and one patient left the country before completing follow up. Of the patients with nerve injury, five patients underwent nerve exploration at the time of operative intervention; three patients had nerves that were intact, one patient’s nerve was caught in the fracture site, and one patient’s nerve was partially lacerated.
Conclusions. Most nerve injuries associated with open forearm fractures recover spontaneously. However, nerve exploration at the time of injury can be justified as nerves can be lacerated upon injury or found incarcerated in the fracture site.
Level of Evidence: IV
