Management of Radial Nerve Lesions after Trauma or Iatrogenic Nerve Injury: Autologous Grafts and Neurolysis

Abstract

Background: Proximal radial nerve lesions located between the brachial plexus and its division into the superficial and deep branches are rare but severe injuries. The majority of these lesions occur in association with humerus fractures, directly during trauma or later during osteosynthesis for fracture treatment. Diagnostics and surgical interventions are often delayed. The best type of surgical treatment and the outcome to be expected often is uncertain. Methods: Twelve patients with proximal radial nerve lesions due to trauma or prior surgery were included in this study and underwent neurolysis (n = 6) and sural nerve graft interposition (n = 6). Retrospective analysis of the collected patient data was performed and the postoperative course was systematically evaluated. The Disabilities of the Arm, Shoulder, and Hand (DASH) and the LSUHS (Louisiana State University Health Sciences) scores were used to determine regeneration after surgery. Comparison between the patients’ and calculated normative DASH scores was performed. Results: All patients had a traumatically or iatrogenically induced proximal radial nerve lesion and underwent secondary treatments. The average time from radial nerve lesion occurrence to surgical intervention was approximately four months (1.5–10 months). Eight patients (66.67%) had a humeral fracture. During follow up, no statistically significant difference between the calculated normative and the patients’ DASH scores was observed. The LSUHS scores were at least satisfactory. Conclusions: Neurolysis or sural nerve graft interposition performed within a specific period of time are the primary treatment options for radial nerve lesions. They should be performed depending on the lesion type. Regeneration to a satisfactory degree was observed in all patients, and the majority achieved full recovery of sensory and motor functions. This was the first study to highlight the efficiency of neurolysis and sural nerve graft interposition as secondary treatment interventions, especially for radial nerve lesions.

Tendon Transfers, Nerve Grafts, and Nerve Transfers for Isolated Radial Nerve Palsy: A Systematic Review and Analysis

“…In the 1940s and 1970s, Seddon 33,34 and Dolenc 28 published their experiences, but details are sparse, making it difficult to quantify their degree of success. More recently, Schwaiger et al, 9 Roganovic et al, 12 and Shergill et al 35 discussed adequate return of function after nerve grafting. However, across all papers, the authors did not include the level of injury, making the data difficult to interpret.…”

“…The grading scale conversion is displayed in Table 1. [5][6][7][8][9] Several papers included functional outcomes at different anatomical levels, namely, at the wrist and finger joints. For these patients, the overall grade assigned was the highest level of strength achieved, but subgrades were noted at each joint for subgroup analysis.…”

Flexor Carpi Radialis Muscle: Anatomic Features and Electromyography Technique Under Ultrasound Control

“…On the other hand, radial nerve proximal lesion between the brachial plexus and nerve division would cause wrist and fingers’ extension loss without any impairment of the FCRM. This is mainly caused by either surgical trauma or humeral fracture [ 13 , 14 ]. Thus, physicians consider that the FCRM is one of the key muscles in diagnosing the site of nerve damage causing upper limb extensors’ deficiency [ 3 ].…”

“…On the other hand, radial nerve proximal lesion between the brachial plexus and nerve division would cause wrist and fingers' extension loss without any impairment of the FCRM. This is mainly caused by either surgical trauma or humeral fracture [13,14].…”

The Role and Efficacy of Fibrin Glue in Repair of Peripheral Nerves; Meta-Analysis Study

“…Author follow up\mn Sallam et al [7] 15.2 Armaiz Flores and Wang [8] 28.2 Hweidi et al [9] 18 [10] 29.600 28.00 -25.280 -84.480 Flores [11] 43 95% CI of rate [%] Sallam et al [7] 43 0 0.000 0.000 -8.221 Schwaiger et al [10] 12 0 0.000 0.000 -26.465 Armaiz Flores and Wang [8] 20 0 0.000 0.000 -16.843 Hweidi et al [9] 15 0 0.000 0.000 -21.802 Wolfe et al [12] 20 0 0.000 0.000 -16.843 Flores [11] 5 2 40.000 5.274 -85.337 Aberg et al [13] 6 [7] 43 0 0.000 0.000 -8.221 Schwaiger et al [10] 12 0 0.000 0.000 -26.465 Armaiz Flores and Wang [8] 20 2 10.000 1.235 -31.698 Hweidi et al [9] 15 10 66.667 38.380 -88.176 Wolfe et al [12] 20 18 90.000 68.302 -98.765 Flores [11] 5 5 100.000 47.818 -100.000 Aberg et al [ [7] 43 3 6.977 1.463 -19.061 Schwaiger et al [10] 12 0 0.000 0.000 -26.465 Armaiz Flores and Wang [8] 20 4 20.000 5.733 -43.661 Hweidi et al [9] 15 0 0.000 0.000 -21.802 Wolfe et al [12] 20 2 10.000 1.235 -31.698 Flores [11] 5 0 0.000 0.000 -52.182 Aberg et al [13] 6 0 0.000 [10] 12 0 0.000 0.000 -26.465 Armaiz Flores and Wang [8] 20 0 0.000 0.000 -16.843 Hweidi et al [9] 15 0 0.000 0.000 -21.802 Wolfe et al [12] 20 0 0.000 0.000 -16.843 Flores [11] 5 0 0.000 0.000 -52.182 Aberg et al [13] 6 0 0.000 0.000 -45.926…”