Both-Bone Forearm Fracture with Median Nerve Injury in 14M

HPI

A 14-year-old right-hand dominant male presents for evaluation of an open right forearm deformity after a fall while playing soccer. He also endorses numbness and tingling in his right thumb, index, and long fingers.

PMH

His past medical history is significant for Iron deficiency anemia, chronic cough, and seasonal allergic rhinitis.

PE

On physical exam, there is an open volar deformity of the right distal forearm with exposed radial and ulnar metaphyseal bone. There is a palpable radial pulse with good capillary refill of the finger tips. Median Nerve: There is no sensation in the hand in the median nerve distribution, specifically thumb, index, long, and half of the ring finger with >8mm 2-point discrimination. There is 0/5 median nerve motor function in the thenar musculature (APB, FPB). 4/5 adductor strength (opponens/adductor pollicis). FDS, FDP to index and long, and FPL are 5/5 Ulnar Nerve: Sensation in the ulnar nerve distribution is grossly intact. Ulnar nerve motor function in the hand is intact (finger adduction and abduction 5/5, negative Froments, negative Wartenberg). FDP to ulnar digits 5/5. Radial Nerve: Sensation in the radial nerve distribution is grossly intact. Radial nerve motor function in the hand/wrist is intact with 5/5 strength (wrist and finger extension, thumb abduction)