J Korean Orthop Assoc.  2011 Feb;46(1):78-81. 10.4055/jkoa.2011.46.1.78.

Incomplete Anterior Interosseous Nerve Palsy That Accompanied a Monteggia Fracture

• Yang BK
• Kim SW
• Yi SR
• Ahn YJ
• Noh JH
• Roh YH
• Lee SW
• Je MS
• Kim SJ

• KMID: 2106576
• DOI: http://doi.org/10.4055/jkoa.2011.46.1.78

Abstract

The anterior interosseous nerve innervates the flexor pollicis longus, the flexor digitorum profundus and the pronator quadratus. There are no sensory fibers from the anterior interosseous nerve leading to the skin. Paralysis of the anterior interosseous nerve that accompanies a Monteggia fracture has rarely been reported, and incomplete paralysis of the anterior interosseous nerve has almost not been reported. We experienced a patient with incomplete anterior interosseous nerve palsy involving the flexor pollicis longus as a complication of a Monteggia fracture. The paralysis of the flexor pollicis longus recovered 4 months after the surgery for the Monteggia fracture.

Keyword

anterior interosseous nerve; incomplete palsy; Monteggia fracture

MeSH Terms

Humans
Monteggia's Fracture
Paralysis
Skin

Figure

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  Figure 1 Initial photogragh shows limitation of thumb interphalangeal flexion with intact distal interphalangeal joint flexion of index finger.

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  Figure 2 Preoperative simple radiographs of left forearm show anterior angulation of proximal ulna fracture and dislocation of radial head.

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  Figure 3 Flexor pollicis longus integrity test suggested by Mody and Melton shows no evidence of the injury of flexor pollicis longus.

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  Figure 4 Postoperative simple radiographs of left forearm show internal fixation of proximal ulna shaft fracture with reduction of radial head.

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  Figure 5 Normal flexion of thumb interphalangeal joint is restored at postoperative 3 months.

Reference

1. Spinner M. The anterior interosseous-nerve syndrome: with special attention to its variations. J Bone Joint Surg Am. 1970. 52:84–94.

2. Vrieling C, Robinson PH, Geertzen JHB. Anterior interosseous nerve syndrome: literature Review and report of 11 cases. Eur J Plast Surg. 1998. 21:189–195.

3. Mody BS. A simple clinical test to differentiate rupture of flexor pollicis longus and incomplete anterior interosseous paralysis. J Hand Surg Br. 1992. 17:513–514.

4. Melton JT, Murray JR, Lowdon IM. A simple clinical test of flexor pollicis longus rupture. J Hand Surg Br. 2005. 30:624–625.

5. Engber WD, Keene JS. Anterior interosseous nerve palsy associated with a Monteggia fracture. A case report. Clin Orthop. 1983. 174:133–137.

6. Kang ES, Han DY, Cho CH. Clinical study on Monteggia fracture. J Korean Orthop Assoc. 1986. 21:1009–1015.

7. Park YB, Lee BK, Lee KW, et al. Factors affecting the functional result of Monteggia fractures in adults. J Korean Soc Fract. 2000. 13:597–604.

8. Sunderland S. The internal topography of the radial, median and ulnar nerves. Brain. 1945. 68:243–299.

9. Spinner M, Schreiber SN. Anterior interosseous nerve paralysis as a complication of supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1969. 51:1584–1590.

10. Geissler WB, Fernandez DL, Graca R. Anterior interosseous nerve palsy complicating a forearm fracture in a child. J Hand Surg Am. 1990. 15:44–47.