Behandlungsbedingte Schäden des N. radialis in der Kindertraumatologie

 

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Zusammenfassung

Hintergrund: Iatrogene Schäden des N. ulnaris sind eine bekannte Komplikation der Versorgung suprakondylärer Oberarmfrakturen im Kindesalter. Aber auch Schädigungen des N. radialis können im Rahmen der Behandlung vieler typischer Frakturen der oberen Extremität im Wachstumsalter auftreten. Über deren Inzidenz liegen keine differenzierten Untersuchungen vor. Patienten und Methoden: Diese Arbeit beschreibt als prospektive Fallsammlung die eigenen Erfahrungen mit dem Auftreten und der Behandlung iatrogener Schäden des N. radialis im Wachstumsalter. Ergebnisse: Von 20 Fällen traten dabei 9 bei der Primärversorgung, weitere 9 im Rahmen der Metallentfernung und 2 anlässlich von Korrekturoperationen auf. 50 % betrafen Versorgungen bei Unterarmschaftfrakturen, 39 % bei distal-metaphysären Frakturen, 11 % bei Radiushalsfrakturen. In 80 % der Fälle war der sensible Endast, in 15 % der motorische Ast und in 5 % der Hauptstamm des Nerven betroffen. Schlussfolgerungen: Die Behandlung iatrogener Nervenschäden darf zurückhaltend sein, spontane Remissionen, insbesondere rein sensibler Ausfallserscheinungen, sind häufig.

Abstract

Background: Iatrogenic damage of the N. ulnaris is a known complication of treatment of supracondylar humeral fractures in children. But damage to the N. radialis can also occur in the treatment of many typical fractures of the upper extremity during growth. There are no differentiated investigations on their incidence. Patients and Methods: This paper presents a prospective case collection and describes the personal experience with the occurrence and treatment of iatrogenic damage to the radial nerve during growth. Results: In all 9 out of 20 cases occurred in the primary care setting, a further 9 under the metal removal and 2 on the occasion of corrective surgery. 50 % occurred after treatment of forearm shaft fractures, 39 % after distal-metaphyseal radius fractures, 11 % after radial neck fractures. In 80 % of the cases the sensory terminal branch was affected, in another 15 % the motor branch and in 5 % the main trunk of the nerve. Conclusions: The treatment of iatrogenic nerve damage should be cautious and restrained, spontaneous remissions, especially of pure sensory deficits, are common.

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