Radial nerve injury associated with humeral shaft fracture: a retrospective study

Ricci, Flávia Pessoni Faleiros Macêdo; Barbosa, Rafael Inácio; Elui, Valéria Meirelles Carril; Barbieri, Cláudio Henrique; Mazzer, Nílton; Fonseca, Marisa de Cássia Registro

doi:10.1590/1413-78522015230100823

Cited by 20 publications

(14 citation statements)

References 19 publications

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“…The low risk of primary neural damage requiring surgical repair (8%) does not justify an early nerve exploration in all the cases with nerve palsy. It could be a viable option in certain cases such as open fractures or cases with high-energy trauma [ 18 , 19 ]. Furthermore, a primary nerve palsy should not influence the decision between conservative or operative treatment and the choice of implant being either a plate or a nail [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome

Schwab

Stillhard

Schibli

et al. 2017

Eur J Trauma Emerg Surg

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IntroductionThe incidence of radial nerve injury after humeral shaft fractures is on average 11.8% (Shao et al., J Bone Jt Surg Br 87(12):1647–1652, 2005) representing the most common peripheral nerve injury associated with long bone fractures (Korompilias et al., Injury, 2013). The purpose of this study was to analyze our current policy and long-term outcome, regarding surgically treated humeral shaft fractures in combination with radial nerve palsy.Materials and methodsWe retrospectively analyzed the data of patients with surgically treated humeral shaft fractures from 01/01/2003 to 28/02/2013. The analysis included fracture type, soft tissue injury regarding closed and open fractures, type of fixation, management, and outcome of radial nerve palsy.ResultsA total of 151 humeral shaft fractures were fixed in our hospital. In 20 (13%) cases, primary radial palsy was observed. Primary nerve exploration was performed in nine cases. Out of the 13 patients with follow-up, 10 showed a complete, 2 a partial, and 1 a minimal nerve recovery. Two of them underwent a revision procedure. Secondary radial nerve palsy occurred in 9 (6%) patients postoperatively. In five patients, the radial nerve was not exposed during the initial surgery and, therefore, underwent revision with nerve exploration. In all 5, a potential cause for the palsy was found and corrected as far as possible with full recovery in 3 and minimal recovery in one patient. In four patients with exposure of the nerve during the initial surgery, no revision was performed. All of these 4 showed a full recovery.ConclusionOur study showed an overall rate of 19% radial nerve palsy in surgically treated humeral shaft fractures. Most of the primary palsies (13%) recovered spontaneously, and therefore, nerve exploration was only exceptionally needed. The incidence of secondary palsy after surgery (6%) was high and mainly seen after plate fixation. In these cases, we recommend early nerve exploration, to detect and treat potential curable neural lesions.

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Section: Discussionmentioning

confidence: 99%

Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome

Schwab

Stillhard

Schibli

et al. 2017

Eur J Trauma Emerg Surg

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“…However, the reported incidence of iatrogenic radial nerve injury is 5.1–17.6%. [ 12 13 14 ] Moreover, plate removal may cause severe radial nerve injuries, leading to deformities including vertical fingers or wrist. Research for our study found that anteromedial plating was performed by inserting the plate from the rear side of the medial brachial intermuscular septum without splitting any muscle.…”

Section: Discussionmentioning

confidence: 99%

“…[ 10 11 ] However, during anterolateral plating, the radial nerve has to be isolated, placed on the surface of the plate or displaced since it moves along the radial nerve groove of the posterior humerus toward the inferior lateral humerus,[ 7 ] and this can cause iatrogenic radial nerve injury, with an incidence rate of 5.1–17.6%. [ 12 13 14 ] Moreover, damage to the muscular branches of the radial nerve is usually difficult to identify, but postoperative triceps muscle strength is often reduced. In addition, the radial nerve is frequently enveloped by a large number of calluses and large amounts of soft tissue scarring generated during fracture healing, which greatly increases the difficulty of plate removal and the incidence of iatrogenic radial nerve injury.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Study of the Fixation Strength of Anteromedial Plating for Humeral Shaft Fractures

Zheng

Zhou

Wang³

et al. 2016

Chinese Medical Journal

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Background:Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures, this study was to compare the mechanical properties of anteromedial, anterolateral, and posterior plating for humeral shaft fractures.Methods:A distal third humeral shaft fracture model was constructed using fourth-generation sawbones (#3404, composite bone). A total of 24 sawbones with a distal third humeral shaft fracture was randomly divided into three Groups: A, B, and C (n = 8 in each group) for anteromedial, anterolateral, and posterior plating, respectively. All sawbones were subjected to horizontal torsional fatigue tests, horizontal torsional and axial compressive fatigue tests, four-point bending fatigue tests in anteroposterior (AP) and mediolateral (ML) directions and horizontal torsional destructive tests.Results:In the horizontal torsional fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 6.12°, 6.53°, and 6.81°. In horizontal torsional and axial compressive fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 5.66°, 5.67°, and 6.36°. The mean plate displacement amplitude was 0.05 mm, 0.08 mm, and 0.10 mm. Group A was smaller than Group C (P < 0.05). In AP four-point bending fatigue tests, the mean plate displacement amplitude was 0.16 mm, 0.13 mm, and 0.20 mm. Group B was smaller than Group C (P < 0.05). In ML four-point bending fatigue tests, the mean plate displacement amplitude were 0.16 mm, 0.19 mm, and 0.17 mm. In horizontal torsional destructive tests, the mean torsional rigidity in Groups A, B, and C was 0.82, 0.75, and 0.76 N·m/deg. The yielding torsional angle was 24.50°, 25.70°, and 23.86°. The mean yielding torque was 18.46, 18.05, and 16.83 N·m, respectively.Conclusions:Anteromedial plating was superior to anterolateral or posterior plating in all mechanical tests except in AP four-point bending fatigue tests compared to the anterolateral plating group. We can suggest that anteromedial plating is a clinically safe and effective way for humeral shaft fractures.

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“…Saraf ini berjalan di spiral groove dari humerus, sehingga lesinya paling banyak disebabkan oleh karena komplikasi fraktur pada shaft humerus (11-18%). 1,2 Lesi nervus radialis menyebabkan…”

Section: Pendahuluanunclassified

Jones Tendon Transfer Modification With Erwin Ramawan Technique

Ramawan

Wardhana

Rahman

2019

JOINTS

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Background: Drop hand is a clinical manifestation of radial nerve lesion that cause hand dysfunction. Jones tendon transfer is one of the therapeutic modalities in overcoming it with many modifications, but there is still no mutual agreement for which technique is the best. One of them is the Erwin Ramawan technique. The purpose of this study was to determine the differences in results before and after tendon transfer surgery with the Erwin Ramawan technique in patients with radial nerve lesions.Methods: Retrospectively, we evaluated patients with high-type lesions of radial nerve carried out by tendon transfer surgery using Erwin Ramawan, to reroute PL to EPL, so the thumb can do abduction and extension, then the FCR tendon is positioned parallel to the ECRB and EDC, then connected 45° direction. The outcome was evaluated using the DASH score and with the Robert G. Chouinard method.Results: The average DASH score in patients with high-type lesions of radial nerve before surgery 56.83 ± 16.69 had a significant improvement (p <0.05) after tendon transfer surgery with Erwin Ramawan technique to 32.00 ± 11.88. Functionally, dorsiflexion from wrist postoperative is 75.00 ± 10.00 (excellent), palmarflexion 52.00 ± 24.65 (excellent). For finger, the metacarpophalangeal extension reaches 166.00 ± 19.49 (good). The distance from the fingertip to metacarpophalangeal crease is 0.10 ± 0.22 (good). On thumb, abduction reaches 40.00 ± 15.81 (excellent), interphalangeal extension 166.00 ± 11.44 (good).Conclusion: Based on these results, we found significant clinical differences before and after tendon transfer with the Erwin Ramawan technique.

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Radial nerve injury associated with humeral shaft fracture: a retrospective study

Cited by 20 publications

References 19 publications

Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome

Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome

Biomechanical Study of the Fixation Strength of Anteromedial Plating for Humeral Shaft Fractures

Jones Tendon Transfer Modification With Erwin Ramawan Technique

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