Complete Recovery of Iatrogenic Radial Nerve Palsy in a Child: A Case Report.

Supracondylar humerus fractures are among the most common paediatric injuries. Although neurologic complications are often seen in these fractures, iatrogenic nerve injuries following closed reduction and percutaneous pinning remain relatively uncommon. Radial nerve palsy is particularly rare in this context, and most cases represent neuropraxic injuries that recover spontaneously. This report describes a rare case of iatrogenic high radial nerve palsy following closed reduction and K-wire fixation of a comminuted supracondylar humerus fracture in a child, with complete functional recovery under conservative management. An eight-year-old boy sustained a comminuted supracondylar humerus fracture after a fall on an outstretched hand. Preoperative neurovascular examination was normal. The patient underwent closed reduction and crossed K-wire fixation, requiring multiple reduction attempts due to fracture comminution. Postoperatively, he developed wrist and finger drop, loss of thumb abduction, and dorsal hand hypoesthesia, consistent with high radial nerve palsy, despite intact distal perfusion and normal postoperative radiographs. Conservative management with close follow-up was initiated. Early neurological improvement was observed at four to six weeks, with radiographic fracture union and K-wire removal at six weeks. By eight weeks, the patient demonstrated complete recovery of wrist extension, thumb abduction, and full elbow range of motion. Radial nerve injury in supracondylar fractures is typically due to traction or entrapment by fracture fragments. Iatrogenic injuries most commonly occur with repeated manipulations during difficult reductions or pin placement. Most such injuries are neuropraxias and recover without surgical intervention. Current evidence supports conservative management unless neurological improvement is absent. To conclude, this case highlights that iatrogenic radial nerve palsy following closed reduction and K-wire fixation, although rare, is usually transient. Thorough clinical assessment and close follow-up are essential. Conservative management can result in complete neurological recovery, and early surgical exploration is generally unnecessary unless deficits persist beyond the expected recovery timeframe.