MEDIAN

NERVE

DECOMPRESSION

AFTER
M.

Front

the

Departtnent

Compression
general,
produces
used to illustrate
decompression.

fracture

Compression
has been

compression
haematoma
Watson-Jones
injUry

of

Trautnatic

H.

and

Orthopaedic

the median
nerve
after
Colless
well
documented.
The
causes
of

with

Sterling
excessive

Surgery,

nerve

damage

and
Habermann
callus
formation

direct

1973),
and

(Kirchman

in the
wound
was

that
have
been
identified
include
within
the carpal
tunnel
(Seddon
1975;
1 976),
hyperextension
at the time of the

hand;
was
found

compressed
the

evacuated.

At

symptoms

and

results

Roal

no improvement
explored
within

conduction

1910;

Cardiff

infirmary

of Colless
fracture,
and treatment,
in
ofcompression
is presented
and four cases
may well account
for the poor results
of

haematoma;

and
healing
with
malunion
(Zachary

FRACTURE

LEWIS

of the median
nerve
is a rare complication
poor results.
A previously
unreported
cause
its significance.
Ignorance
of this complication

of

COLLESS

beneath

ligament
six

extensive

was

weeks

signs

studies
are

occurred
seventy-two

were

in keeping

still

palmar

ligament

completely

and

wasting

carried

out

quite

a severe

damage

of the

the bandage
and the
of injury.
The nerve

complained

thenar

with

proximal

the
divided

she

of

on splitting
hours

of
were

and

by
the

the

median

nerve

apparent.
report

median

tense

haematoma
Nerve

read:

nerve

injury

These
due

to

nerve.

1945).

The
previously

purpose
of this paper
unreported
cause

haematoma

and

subsequent

fascia

level

of the fracture

at the

carpal

tunnel.

The

is to draw
attention
to a
of compression:
namely,
fibrosis

investigation

1. A woman

the

right

forearm.

anatomical
there

no

forearm

with

forty-eight
At

the

loosely

with

three
the

weeks

Case

the

hours

M. H.
Cardiff

right

anatomical
later

Lewis,
CF2

60.-B,

aged

forearm.
result

the

patient

2. MAY

the

deep

fascia

of

The

at operation

showing
inches

narrowing
above

of the

the

median

nerve

three

wrist.

performed

studies
level

was

forearm.

and

on the
that

of the

incision

At

to be compressed

proximal

evacuated

fell and
1, there

the

skin

nerve

there

apart
The

closed

performed

was

haematoma.

sustained
was

immobilisation

complained

Mrs

Photograph

of the

damage
After

three

bitterly

0.

Blanche,

a Colless
reduction

with

in plaster

of Paris.

Twelve

of median

nerve

Department

operation

the

carpal

some

fibrous

adhesions.

however,

it was

found

to be

proximal

to the

skin

below

the

no response
was

divided

and

the

and

a neurolysis

operation

resulted

and

Cases

3 and

nerve

symptoms

symptoms

in

of Traumatic

and

the

crease

signs

Orthopaedic

other

have
twelve

by fibrosis
wrist

to be normal

(Fig.

abduction

of the

this

The

nerve

patients

One

Cardiff

inches

stimulator
thumb,
fibrous

was

improvement

but
tissue

uneventful,
in

both

the

compression.

with
this

lesion.

Recovery

marked

three

1). A nerve

above

performed.

proximally,

some

caused

months.

Surgery,

found
the nerve

area

in

attended

was

exploring

placed

of median

4. Two

past

of the

when

tunnel

On

narrowed

constricted

occurred

symptoms

fracture

a closed

a further

from

placed
to

of symtoms.

in Case

1978

Fig. i

the

length
was

found

of the

confirmed

at the

and

of Paris
hours

the

normal.

nerve

haematoma

free

F.R.C.S.,
do
1SZ, Wales.

No.

was

and

sixty-four
As

along

decompression

Conduction

was

in plaster

injury.

operation
nerve

patient

2. A woman

good

VOL.

sutures.

after
median

the

of the

the

of

a good

in the distribution

divided

tunnel

the

divided,

silk

proximal

months

carpal

beneath
was

initial

fracture
with

twenty-four

paraesthesia

was

proximally

by a haematoma

by an
was

a Colless

performed,

within

Surgical

the

clinical
carpal
during

undertaken
exploration

immobilisation
but

and

bandage

after

extended

fascia

after

no improvement.

operation

therefore
deep

the

hours

was

deficit

of numbness

nerve;

the

a patient

this led to the

had undergone
complication

sustained

reduction

Immediately

complained
median

deep

from

when

were
second

fell and

neurological

the

away

REPORTS

fity-six

Closed

result.

was

patient
the

aged

and
who
this

studies
A

CASE
Case

well

began

presented
with the condition
review
of three other
patients
tunnel
decompression
for
1976;
nerve
conduction
independent
neurologist.
necessary
in one case.

beneath

site,

Colless

department
had

Royal

fractures

and

for surgical
a

poor

Infirmary,

result

Newport

median

treatment
and

the

Road,

I9

I 96

M.

electromyographic
age

He

minimal
the

studies
is awaiting

symptoms

nerve

study

after
was

suggested

further

similar

exploration.

decompression

reported

proximal

The

nerve

fourth

of the carpal

LEWIS

dam-

patient

tunnel

H.

haemorrhagic
compression
in the carpal
tunnel.
In three
of the four
cases
that required
exploration
there
was
proximal
median
nerve
damage
at the level
of the
fracture
site. Two of these required
surgical
intervention

had

alone,

and

as normal.

for full recovery

awaits
a second

DISCUSSION
Undoubtedly

median

nerve

compression

after

a Colless

fascia
can

at the
occur

I would
like to acknowledge
thank
Dr R. L. Blandford

level
alone

of the fracture
or simultaneously

with thanks
for carrying

the help and

out the nerve

site.

place;
the
therefore,
are
then

third
that
severe
if the

carpal
tunnel
appears
normal
the dissection
should
be
extended
to include
at least four inches
of the proximal

This
with

advice
given
conduction

nerve
to take
It is suggested,

if the symptoms
of median
nerve
compression
enough
to warrant
surgical
intervention

fracture
can be due to compression
within
the carpal
tunnel
by a haematoma.
However,
these
cases illustrate
that compression
may be due to a haematoma
beneath
the deep
condition

of the
operation.

forearm.
tunnel

It may not be enough

alone
even
if compression

to me by Professor
studies
and Mrs

G.

to explore
is found

B. McKibbin
in the preparation
Blanche
for her secretarial

of this
assistance.

the carpal
at this site.

paper,

and

also

to

REFERENCES
Klrchman,
Seddon,

T. (1910)
H.

J.

(1975)

Uber
Surgical

Verletzungen
Disorders

des
ofthe

N medianus
Peripheral

bei fracture
Nerves.

radii.
Second

Sterling,
A. P., and Habermann,
E. T. ( 1 973) Acute
post traumatic
median
the wrist.
Bulletin
ofthe
Hospital
for Joint
Diseases,
34, 167-171.
Watson-Jones,
R. (1976)
Fractures
and Joint
Injuries.
Fifth
edition.
Edited
Churchill
Livingstone.
Zachary,
R. B. ( I 945)
Thenar
palsy
due to compression
of the median
81, 213-217.

Klassischer
edition,
nerve

p.

Thesis,
Edinburgh

compression

by Wilson,
nerve

Stelle
119.

in the

Frederick-Wilhelm

associated

J. N. Vol.
carpal

THE

and
with

a Salter

II, p. 755.
tunnel.

JOURNAL

Universitaet,

London:

Livingstone.

II fracture

dislocation

Edinburgh,

Surgery,

London,

Gynecology

OF BONE

Berlin.

Churchill

AND

New
and

JOINT

of
York:

Obstetrics,

SURGERY