Lesión del nervio cubital tras fractura cerrada de antebrazo – dos casos clínicos

Resumen

Las lesiones nerviosas asociadas a la fractura cerrada de los huesos del antebrazo son poco frecuentes y generalmente consisten en lesiones parciales del nervio mediano. Hay pocos casos publicados de una lesión grave del nervio cubital asociada a una fractura cerrada del antebrazo. Presentamos dos casos clínicos de lesiones del nervio cubital consecuencia de una fractura cerrada de antebrazo. Un diagnóstico precoz y la detección de los signos clínicos de gravedad son fundamentales, ya que influyen directamente en la actitud a tomar y en el resultado del tratamiento. Los casos que se presentan, se trataron de forma quirúrgica y se encontraron lesiones nerviosas severas. Es difícil estandarizar el tratamiento, ya que existen distintas causas de lesión nerviosa y un rango amplio de gravedad. Tras analizar la mayoría de los casos publicados, la recomendación inicial es esperar la mejora espontánea de cuatro a seis meses. Si después de ese período, no hay mejoría de la sintomatología neurológica, está indicado realizar una exploración microquirúrgica del nervio. Se revisan algunos signos de gravedad que pueden indicar un tratamiento quirúrgico precoz.

Abstract

Nerve lesions associated to closed forearm bone fractures are rare, and usually consist of a partial injury to the median nerve. There are very few reports of a severe ulnar nerve injury associated to closed forearm fracture. We describe two cases of ulnar nerve lesion caused by closed forearm fracture. Early diagnosis and the importance of detecting red-flag clinical signs are stressed, as they directly influence the measures to follow and treatment outcome. Our patients were surgically treated, and severe nerve injuries were observed. It is hard to standardize the treatment, due to different causes of nerve lesion and the wide range of severity. By analyzing most reported cases, the initial recommendation is to wait for spontaneous improvement during four to six months. If after this time lapse there is no neurological symptom improvement, there is an indication for nerve microsurgical exploration. We have also reviewed some red-flag signs that may warrant early surgical treatment.

Palabras Clave

nervio ulnar - lesiones nervio periférico - lesiones del antebrazo - fracturas de la ulna

Keywords

ulnar nerve - peripheral nerve injuries - forearm injuries - ulna fractures

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