Spontaneous Full Recovery of High Radial Nerve Palsy Following Closed Reduction and Percutaneous Pinning of Gartland IV Supracondylar Fracture: A Case Report

BACKGROUND Supracondylar fracture is one of the most common pediatric traumatic fractures. It is subclassified into 2 entities: the extension type, which is predominantly seen, and the flexion type. It can be further classified into 4 types according to the Gartland classification, which assesses the anatomical severity of the fracture depending on the lateral radiographs of the elbow and operative findings. The usual mechanism of injury is falling on outstretched hands. CASE REPORT This study presents a rare case of high radial nerve palsy seen in an 8-year-old previously healthy male patient after closed reduction and percutaneous pinning of a Gartland type IV supracondylar fracture using 2 lateral diverging pins and 1 medial crossing pin. Several attempts of forceful maneuvers were needed to anatomically reduce the fracture. X-rays and contrasted CT scan were done after the surgery, confirming proper placement of pins and intact vascularity. However, a CT scan revealed a large hematoma in the posterior compartment of the arm and subcutaneous edema with soft-tissue swelling at the left elbow. A conservative management plan was established with serial physical examination and follow-up for the next 3-6 months. Subsequently, the patient experienced dramatic improvement of nerve function over 6 weeks following the surgery, and complete recovery of radial nerve motor and sensory function was achieved 2 months after the operation. CONCLUSIONS Most nerve injuries are a neuropraxic nerve injuries, which resolve spontaneously without intervention. Physicians usually reserve any surgical intervention in case of progressive worsening of neurological deficit or if no improvement occurs in 3-6 months.