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

Schwab, Thomas R.; Stillhard, Philipp; Schibli, Silvia; Furrer, Markus; Sommer, Christoph

doi:10.1007/s00068-017-0775-9

Cited by 78 publications

(72 citation statements)

References 22 publications

(42 reference statements)

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“…Previous studies have demonstrated iatrogenic radial nerve injuries occur in 6-32% of plated humeral shaft fractures. [5][6][7][8][9] None were observed in this study.…”

Section: Discussionmentioning

confidence: 99%

The modified anterolateral approach to the humerus

Chang

Sagar

et al. 2019

J Orthop Surg (Hong Kong)

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Introduction: The anterior and anterolateral approaches to the humerus describe splitting brachialis longitudinally, assuming its fibres run parallel to the shaft. Recent improvements in the understanding of brachialis anatomy however have demonstrated it has two distinct heads, with the bulk of its fibres running oblique relative to the humerus. Attempting to split brachialis longitudinally to the extent required for plate osteosynthesis invariably leads to transection of a significant number of muscle fibres. The authors present a less muscle destructive modification to the anterolateral approach (ALA) based on a bicipital brachialis muscle. Method: In order to preserve brachialis muscle fibres, the modified ALA elevates the superficial head from the underlying humerus and longitudinally splits the deep head to allow a fixation device to be tunnelled. Case notes of patients with a humeral shaft fracture fixed via the modified ALA were retrospectively reviewed. Results: Ninteen humeral shaft fractures were fixed via the modified ALA. No post-operative nerve palsies were reported. Of the 19 patients, 14 (73.7%) received clinical and radiological follow-up. All reported being satisfied with their outcome. One developed a superficial wound infection and one (previous diagnosis of spondyloepiphyseal dysplasia tarda) developed a non-union requiring revision surgery. Of the five patients lost to follow-up, two died, and three reported no ongoing orthopaedic issues via telephone. Conclusions: Improved anatomical understanding of brachialis has resulted in the described modification to the ALA which is less muscle destructive and follows a truer inter-nervous plane. This small series demonstrates satisfactory outcomes using this approach.

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“…Previous studies have demonstrated iatrogenic radial nerve injuries occur in 6-32% of plated humeral shaft fractures. [5][6][7][8][9] None were observed in this study.…”

Section: Discussionmentioning

confidence: 99%

The modified anterolateral approach to the humerus

Chang

Sagar

et al. 2019

J Orthop Surg (Hong Kong)

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“…A “secondary radial palsy” during fracture manipulation or reduction can occur as a result of intraoperative nerve exploration or the surgical approach used [ 13 ]. The radial nerve is extremely sensitive to even slight tension exerted during surgical exploration of the fracture.…”

Section: Reviewmentioning

confidence: 99%

“…The radial nerve is extremely sensitive to even slight tension exerted during surgical exploration of the fracture. The position of the patient during general anesthesia is also a causative factor as loss of muscle tone can lead to inadvertent traction at the fracture site and compression of the radial nerve [ 13 ]. For the most part, radial nerve entrapment is seen after fracture manipulation when the nerve is unknowingly entrapped between bone and an installed plate, compressed by a bone fragment or if excessive nailing of the bone occurs [ 14 ].…”

Section: Reviewmentioning

confidence: 99%

Injury of the Radial Nerve in the Arm: A Review

Latef¹,

Bilal²,

Vetter

et al. 2018

Cureus

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Compression of the radial nerve is most commonly described at the supinator muscle (i.e., arcade of Frohse). However, radial nerve compression can occur in the arm. Therefore, the purpose of this article is to review both etiologies of radial nerve entrapment and the sites at which this can occur in the arm. The clinical presentation of radial nerve entrapment in the arm and how it differs from that of entrapment at other sites is reviewed and the conditions potentially predisposing to nerve entrapment are described. Particular attention is paid to the nerve’s course and potential variants of the anatomical structures in the arm. In each case, the recommended course of management for the neuropathy is described. Injury of the radial nerve can arise from a varied set of pathologies including trauma, tumors, anomalous muscles, and intramuscular injections. Physicians should have a good working knowledge of the anatomy and potential mechanisms for radial nerve injury.

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“…In humerus fractures, RNI is common due to the mechanism of fracture formation and the sharpness of fracture ends. In addition, RNI is a common case during fracture surgery [2,3,4]. Since the radial nerve is located in the intermuscular area, it is easily affected by tension caused by loosening or pulling during surgery (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

“…Since the radial nerve is located in the intermuscular area, it is easily affected by tension caused by loosening or pulling during surgery (Figure 2). Besides, abnormal movements cause nerve strain and nerve injury due to the patient's inability to control his/her arm after anesthesia [4][5][6]. For this reason, it is very important for the assistant health personnel to be attentive in the surgery of distal humerus fractures.…”

Section: Discussionmentioning

confidence: 99%

Researching the effect of radial nerve injury in humerus shaft fractures

2020

Ann Clin Anal Med

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Aim: Radial nerve injury (RNI) is a frequently encountered condition in distal humeral shaft fractures. However, few studies have researched the effect of RNI on fracture healing and extremity functions in patients. In this study, we examined the fracture union time and functional results of the extremity in patients with humerus shaft fracture and RNI. Material and Methods: Thirty patients who underwent osteosynthesis with plaque due to 1/3 distal shaft fracture were included in our clinic between 2012 and 2019. We divided the patients with at least 12 follow-ups with and without RNI into two groups. We compared the union time of the fractures of these groups and their functional results after the fracture healing. We used the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire for upper extremity function measurement. Results: Nine (30%) out of 30 patients had RNI. Fractures of 28 patients (93.3%) were healed without the need for a second operation. Eight (88.8%) out of 9 patients with RNI demonstrated complete healing and 1 patient (11.2%) partial healing. No significant difference was found in patients with and without RNI in terms of fracture union time. DASH scores of patients with RNI were worse than patients without RNI. Discussion: Although isolated RNI developed after humerus fracture does not negatively affect fracture healing rate and time, RNI developing after fracture negatively affects functional results of upper extremity.

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

Cited by 78 publications

References 22 publications

The modified anterolateral approach to the humerus

The modified anterolateral approach to the humerus

Injury of the Radial Nerve in the Arm: A Review

Researching the effect of radial nerve injury in humerus shaft fractures

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