Posterior interosseous nerve palsy after closed proximal forearm fractures

Bulstra, Liselotte F.; Schep, N.W.L.; Vlies, Cornelis H. van der

doi:10.1016/j.tcr.2019.100240

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…Iatrogenic posterior interosseous nerve injury is rarely seen in forearm surgical treatment. It has been reported that this risk can be minimized especially in nail operations by keeping the proximal locking screw of the radial nail at least 30 mm from the radius head and keeping the forearm in neutral rotation.As the radius fracture approaches to proximal in patients who receive plate, more attention must be paid in terms of nerve damage [24]. In our study, attention was paid to these issues in patients using both plate and locked nails, and therefore no iatrogenic posterior interosseous nerve injury was observed.…”

Section: Discussionmentioning

confidence: 87%

The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail

Çevik

Akalın

Öztürk

2020

The European Research Journal

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Objectives: The results of two different methods applied in the surgical treatment of forearm fractures in adults were evaluated. Methods: Thirty-nine patients who applied to our clinic between 2016-2018 and were treated surgically were included in the study. Twenty-three patients out of these were treated with plate osteosynthesis (group 1), and 16 patients were treated with intramedullary locking nail (group 2). While 14 of the patients in group 1 were male, 9 were female, and the average age was 39.8 years (range; 19-74 years); and 11 of the patients in group 2 were male, 5 were female, and the average age was 36.6 years (range; 18-68 years). Patients were called for monthly check-ups until fracture union. Then, radiographic evaluation was done at 3, 6 and 12 months. The average follow-up time was 26 months (range;12-36 months) for group 1 and 25 months (range;12-35 months) for group 2. The loss of the line of fracture through radiographic imaging of trabeculations or callus formation in the cortex on the anteroposterior and lateral radiographs, and clinically loss of sensitivity on fracture were considered fracture union. In the last controls, while the elbow was at 90 degrees of flexion, the amount of rotation of both forearms was measured by using the goniometer. In the functional evaluation, the system described by Grace and Eversmann and used to evaluate fracture union and forearm rotation was used. Patient satisfaction was evaluated by using the DASH (Disabilities of the Arm, Shoulder and Hand) method. Results: While the union duration in group 1 was 12.3 weeks (range; 8-18 weeks), the union duration in group 2 was 12 weeks (range; 9-16 weeks). There was no statistical difference in terms of union durations (p > 0.05). In Group 1, according to the Grace-Eversmann evaluation, 19 (82.6%) patients had excellent and good results, three (13.1%) patients had acceptable results, and 1 (4.3%) patient had poor results. Forearm pronation of the patient with poor results was less than 60% but his bone union was complete. In group 1, the average DASH score was 15.04 (range; 3-28). In group 2, Grace-Eversmann evaluation showed excellent and good results in 13 (81.3%) patients and acceptable results in 3 (18.7%) patients. Average DASH score was found to be 14.6 (range; 2-34). When Grace-Eversmann criteria and DASH values were compared, no significant difference was found between the two groups (p > 0.05). Vascular nerve injury, tendon injury, radioulnar synostosis, and compartment syndrome were not observed in any patient. Conclusions: The results of the two fixation methods in terms of functional recovery and patient satisfaction were similar in the surgical treatment of forearm double fractures in adults.

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Section: Discussionmentioning

confidence: 87%

The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail

Çevik

Akalın

Öztürk

2020

The European Research Journal

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“…Without the exploration of nerve, the grade can be assumed based on indirect evidences, from physical examination and electromyography (EMG) studies [ 12 ]. However, this could not be differentiate whether the nerve involved is stretched or entrapped.…”

Section: Discussionmentioning

confidence: 99%

Type III Monteggia Fracture–dislocation with Radial Nerve Injury in Adults – A Case Report of two Cases

Krishna¹,

Jagadeesh²,

Sathiyaseelan³

et al. 2023

JOCR

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Introduction: Uncommon complication of Monteggia fracture is associated PIN palsy. The PIN palsy following Monteggia fracture–dislocation is neuropraxias and will recover spontaneously. Case Reports: Two cases who were diagnosed as Monteggia fracture–dislocation with PIN palsy and associated superficial branch of radial nerve injury – Power 0/5 and sensations 0/2 were taken up for surgery (open reduction internal fixation of fracture of ulna + closed reduction of radial head). By the end of 7 weeks, both sensory and motor power were fully recovered spontaneously in both the cases. Discussion: Most of the PIN injuries following Monteggia fracture–dislocation are neuropraxias and will recover spontaneously after closed reduction of radial head without any intervention to the nerve. The nerve needs to be intervened if there are no signs of recovery by 3 months. The time frame for the nerve to be intervened remains controversial. Conclusion: In both of our cases, the injury is probably proximal to the terminal division of radial nerve and the injuries were neuropraxias and have recovered spontaneously. Hence, we suggest not exploring the nerve in all cases with Monteggia fracture–dislocation immediately even when there is associated sensory deficit. Keywords: Monteggia fracture–dislocation, PIN palsy, neuropraxia.

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“…Available follow-up data of proximal radius fracture-related posterior interosseous nerve palsies in children are limited. Case reports of adults generally show spontaneous recovery between 2 mo and 6 mo after injury, and operative intervention is rarely required[ 10 , 11 , 50 , 51 ].…”

Section: Complicationsmentioning

confidence: 99%

Diagnosis, treatment and complications of radial head and neck fractures in the pediatric patient

Macken

Eygendaal

Bergen

2022

WJO

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Radial head and neck fractures represent up to 14% of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient. In up to 39% of proximal radius fractures, there is a concomitant fracture, which can easily be overlooked on the initial standard radiographs. The treatment options for proximal radius fractures in children range from non-surgical treatment, such as immobilization alone and closed reduction followed by immobilization, to more invasive options, including closed reduction with percutaneous pinning and open reduction with internal fixation. The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient; an angulation of less than 30 degrees and translation of less than 50% is generally accepted, whereas a higher degree of displacement is considered an indication for surgical intervention. Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures, range of motion and complications compared to severely displaced fractures requiring surgical intervention. With proper management, good to excellent results are achieved in most cases, and long-term sequelae are rare. However, severe complications do occur, including radio-ulnar synostosis, osteonecrosis, rotational impairment, and premature physeal closure with a malformation of the radial head as a result, especially after more invasive procedures. Adequate follow-up is therefore warranted.

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Posterior interosseous nerve palsy after closed proximal forearm fractures

Cited by 6 publications

References 11 publications

The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail

The functional and radiological comparison of the surgical treatment results of forearm diaphyseal fractures in adults treated with open reduction internal fixation and intramedullary locking nail

Type III Monteggia Fracture–dislocation with Radial Nerve Injury in Adults – A Case Report of two Cases

Diagnosis, treatment and complications of radial head and neck fractures in the pediatric patient

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