A Rare Case of Posterior Interosseous Nerve Palsy Associated With Radial Head Fracture

Serrano, Karen; Rebella, Gregory S.; Sansone, Jason M.; Kim, Michael K.

doi:10.1016/j.jemermed.2009.10.017

Cited by 11 publications

(8 citation statements)

References 9 publications

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“…Naturally, traumas at this level such as radial head or neck fractures or fractures of the proximal shaft of the radius also carry the risk of PIN injury. However, only few cases of PIN injury after fractures of the radial head or neck have been described (Table 1) [[3], [4], [5], [6], [7]]. Of these five reported cases, the PIN injury was treated non-operatively in four and in only one case PIN release was performed.…”

Section: Discussionmentioning

confidence: 99%

“…One patient was lost to follow-up and outcomes are unknown. All other four patients reported complete recovery after various follow-up (range 2 days–6 months) [[3], [4], [5], [6], [7]].…”

Section: Discussionmentioning

confidence: 99%

“…The etiology of PIN palsy in fractures with a non- or minimally displaced radial head has not been fully clarified. Possible theories include PIN compression by edematous surrounding tissue or fracture hematoma, direct damage from a fractured radius fragment and iatrogenic damage during closed reduction [[3], [4], [5], [6], [7]].…”

Section: Discussionmentioning

confidence: 99%

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Posterior interosseous nerve palsy after closed proximal forearm fractures

Bulstra

Schep

Vlies

2019

Trauma Case Reports

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Although rare, posterior interosseous nerve (PIN) palsy can occur in patients with a closed proximal forearm fracture and may present in a delayed fashion after initial trauma. In this case series, three cases of posterior interosseous nerve (PIN) injury following proximal forearm fractures are presented and discussed. Our literature search yielded six studies concerning PIN injury in radial head/neck fractures and proximal forearm fractures. Out of a total of 8 patients, 7 patients were treated non-operatively and in one patient a PIN release was performed. One patient was lost to follow-up, all other 7 patients showed successful recovery. A treatment algorithm for PIN palsy after proximal forearm fractures is provided. Based on our experience and what we found in literature, it seems safe to treat PIN palsies conservatively.

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Section: Discussionmentioning

confidence: 99%

“…One patient was lost to follow-up and outcomes are unknown. All other four patients reported complete recovery after various follow-up (range 2 days–6 months) [[3], [4], [5], [6], [7]].…”

Section: Discussionmentioning

confidence: 99%

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Posterior interosseous nerve palsy after closed proximal forearm fractures

Bulstra

Schep

Vlies

2019

Trauma Case Reports

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“…10 Fractures of the radial head and neck, and radius/ulna fractures can damage the posterior interosseous nerve. 11,12 …”

Section: Aetiologymentioning

confidence: 99%

Radial nerve palsy

Bumbaširević

Palibrk²,

Lešić

et al. 2016

EFORT Open Reviews

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As a result of its proximity to the humeral shaft, as well as its long and tortuous course, the radial nerve is the most frequently injured major nerve in the upper limb, with its close proximity to the bone making it vulnerable when fractures occur.Injury is most frequently sustained during humeral fracture and gunshot injuries, but iatrogenic injuries are not unusual following surgical treatment of various other pathologies.Treatment is usually non-operative, but surgery is sometimes necessary, using a variety of often imaginative procedures. Because radial nerve injuries are the least debilitating of the upper limb nerve injuries, results are usually satisfactory.Conservative treatment certainly has a role, and one of the most important aspects of this treatment is to maintain a full passive range of motion in all the affected joints.Surgical treatment is indicated in cases when nerve transection is obvious, as in open injuries or when there is no clinical improvement after a period of conservative treatment. Different techniques are used including direct suture or nerve grafting, vascularised nerve grafts, direct nerve transfer, tendon transfer, functional muscle transfer or the promising, newer treatment of biological therapy.Cite this article: Bumbasirevic M, Palibrk T, Lesic A, Atkinson HDE. Radial nerve palsy. EFORT Open Rev 2016;1:286-294. DOI: 10.1302/2058-5241.1.000028.

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“…Although this is a rare injury, Hausmann et al reported on partial ruptures of the IOM diagnosed with MRI in nine of 14 patients with a Mason type I fracture, suggesting that injuries of the IOM are more frequent than generally expected [29]. Severe anterior displacement of the radial head may cause injury to the radial nerve [1]. Posterior interosseus nerve injury has also been reported in the literature [30,31]. Brachial artery injury occurs in 0.3% to 1.7% of elbow dislocations [32]. Neurologic problems occur in 20% of elbow dislocations.…”

Section: Associated Injuriesmentioning

confidence: 99%

Management of Radial Head Fractures: Current Concepts

et al. 2011

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Radial head fractures are common injuries and are accompanied by clinically relevant associated injuries in over one-third of patients. They are commonly classified by the Mason classification or one of its modifications. Type I fractures are treated conservatively with early mobilization. Type II fractures can be treated conservatively or by open reduction and internal fixation (ORIF), depending on fragment size and dislocation. Bony restriction in forearm rotation is an indication for surgical treatment. Type III fractures are treated surgically, by means of ORIF, prosthetic replacement or excision. Comminuted fractures with more than three fragments are regarded as unsuitable for ORIF. However, optimal treatment of type II and III fractures is still the subject of debate and there is a strong need for randomized clinical trials and uniform fracture classification and outcome measures.

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A Rare Case of Posterior Interosseous Nerve Palsy Associated With Radial Head Fracture

Cited by 11 publications

References 9 publications

Posterior interosseous nerve palsy after closed proximal forearm fractures

Posterior interosseous nerve palsy after closed proximal forearm fractures

Radial nerve palsy

Management of Radial Head Fractures: Current Concepts

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