The role of the Richet – Canu anastomosis in the diagnosis of post-traumatic neuropathy of the median nerve in transcondylar fractures in children

INTRODUCTION. The incidence of peripheral nerve injuries varies from 2–35 %, and the frequency of peripheral nerve injuries is second in the structure of all fractures in children. The pattern of nerve damage distribution in transcondylar fractures is heterogeneous, with the median nerve accounting for up to 43.4 %. In a number of cases, the clinical picture of posttraumatic neuropathy of the median nerve is represented by isolated sensory and autonomic disorders, which, from the anatomical point of view, are explained by the presence of the Richet – Canyou anastomosis compensating for the motor deficit. The role of electro diagnostic medicine (nerve conduction study (NCS)) as a non-invasive method of confirming the presence of anastomosis increases in case of dissociation of symptoms.
AIM. To evaluate the effect of the Richet – Canoux anastomosis on the clinical picture and electroneuromyographic data in the case of median nerve neuropathy complicated trans condylar fractures in children on the example of our own clinical group, to compare the obtained results with international data and to determine the indications for surgical treatment.
MATERIALS AND METHODS. Outpatient records and case histories of 15 patients aged 4 to 8 years who applied for consultative care in the period from 2022 to 2023 in the consultative-diagnostic center of the Research Institute of Research Institute of Emergency Pediatric Surgery and Traumatology were analyzed.
RESULTS. Of the 6 patients with sensory and autonomic disorders, five required surgical intervention, during which 3 patients underwent neurolysis, one underwent neurorhaphy of the sensory portion of the median nerve, and one underwent autotransplantation for trunk transposition in the fracture line. Clinical features and electroneuromyography and neuroimaging data in the presence of a Richet-Canine anastomosis are presented in two clinical examples.
CONCLUSION. The prevalence of the Richet – Canyou anastomosis detected in our clinical group coincided with the literature data. Clinical examples demonstrate the possibility of preservation of the tenar musculature and dominance of sensory and autonomic disorders in the clinic in the presence of anastomosis confirmed by NCS. Patients with dominant persistent autonomic and sensory disorders became candidates for surgical treatment.

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