Primary radial nerve palsy associated with humeral shaft fractures according to injury mechanism: is early exploration needed?

Kong, Chae-Gwan; Sur, Yoo Joon; Jung, Jae Woong; Park, Ho Youn

doi:10.1016/j.jse.2021.07.013

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…Radial nerve palsy has been associated with humeral shaft fractures, with documented rates of approximately 10%2, 43,44 . Radial nerve injuries can be iatrogenic but also are associated with high-energy fracture patterns 45 . In the present meta-analysis, patients who were treated with ORIF were significantly more likely to sustain iatrogenic radial nerve injury (6.3%) compared with those who were treated with functional bracing (0.5%) and MIPO (2.3%).…”

Section: Discussionmentioning

confidence: 99%

Conservative Management with Functional Brace Versus Various Surgical Fixation Techniques for Humeral Shaft Fractures

Zavras

Monahan

Winek

et al. 2023

Journal of Bone and Joint Surgery

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Background: Historically, humeral shaft fractures have been successfully treated with nonoperative management and functional bracing; however, various surgical options are also available. In the present study, we compared the outcomes of nonoperative versus operative interventions for the treatment of extra-articular humeral shaft fractures.Methods: This study was a network meta-analysis of prospective randomized controlled trials (RCTs) in which functional bracing was compared with surgical techniques (including open reduction and internal fixation [ORIF], minimally invasive plate osteosynthesis [MIPO], and intramedullary nailing in both antegrade [aIMN] and retrograde [rIMN] directions) for the treatment of humeral shaft fractures. The outcomes that were assessed included time to union and the rates of nonunion, malunion, delayed union, secondary surgical intervention, iatrogenic radial nerve palsy, and infection. Mean differences and log odds ratios (ORs) were used to analyze continuous and categorical data, respectively.Results: Twenty-one RCTs evaluating the outcomes for 1,203 patients who had been treated with functional bracing (n = 190), ORIF (n = 479), MIPO (n = 177), aIMN (n = 312), or rIMN (n = 45) were included. Functional bracing yielded significantly higher odds of nonunion and significantly longer time to union than ORIF, MIPO, and aIMN (p < 0.05). Comparison of surgical fixation techniques demonstrated significantly faster time to union with MIPO than with ORIF (p = 0.043). Significantly higher odds of malunion were observed with functional bracing than with ORIF (p = 0.047). Significantly higher odds of delayed union were observed with aIMN than with ORIF (p = 0.036). Significantly higher odds of secondary surgical intervention were observed with functional bracing than with ORIF (p = 0.001), MIPO (p = 0.007), and aIMN (p = 0.004). However, ORIF was associated with significantly higher odds of iatrogenic radial nerve injury and superficial infection than both functional bracing and MIPO (p < 0.05).Conclusions: Compared with functional bracing, most operative interventions demonstrated lower rates of reoperation.MIPO demonstrated significantly faster time to union while limiting periosteal stripping, whereas ORIF was associated with significantly higher rates of radial nerve palsy. Nonoperative management with functional bracing demonstrated higher nonunion rates than most surgical techniques, often requiring conversion to surgical fixation.

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Section: Discussionmentioning

confidence: 99%

Conservative Management with Functional Brace Versus Various Surgical Fixation Techniques for Humeral Shaft Fractures

Zavras

Monahan

Winek

et al. 2023

Journal of Bone and Joint Surgery

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“…We found no reports on the fracture-related risk of nerve injuries associated with pediatric forearm fractures. The risk of nerve injury is increased in children with an open fracture or a fracture caused by high-energy trauma 6,7 . Most nerve injuries in children with forearm fractures have been reported as temporary, but the risk of permanent nerve injury resulting from the fracture is unknown 6,[8][9][10][11] .…”

mentioning

confidence: 99%

The Risk of Nerve Injury in Pediatric Forearm Fractures

Zilliacus

Nietosvaara

Helenius

et al. 2023

Journal of Bone and Joint Surgery

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Background: The risk of fracture-related nerve injury associated with forearm fractures in children is unknown. The purposes of the present study were to calculate the risk of fracture-related nerve injury and to report the institutional rate of complications of surgical treatment of pediatric forearm fractures.Methods: Four thousand, eight hundred and sixty-eight forearm fractures (ICD-10 codes S52.0 to S52.7) that had been treated in our tertiary level pediatric hospital between 2014 and 2021 were identified in our institutional fracture registry. Of these, 3,029 fractures occurred in boys and 53 were open fractures. Sex, age at injury, trauma mechanism and energy, fracture type, treatment method, and cause and type of nerve injury were assessed in 43 patients with 44 registered nerve injuries. Patients with nerve injuries were reevaluated to calculate the recovery time. Univariable and multivariable regression analyses were performed to determine the risk of nerve injury. Results:The risk of a fracture-related nerve injury was 0.7% (33 of 4,868). Only 2 injuries were permanent; thus, the risk of permanent nerve injury associated with a forearm fracture was 0.04% (2 of 4,868). The ulnar nerve was affected in 19 cases; the median nerve, in 8; and the radial nerve, in 7. In cases of open fracture, the risk of nerve injury was 17% (9 of 53). Open fractures had an OR of 33.73 (95% CI, 14.97 to 70.68) on univariate analysis and an OR of 10.73 (95% CI 4.50 to 24.22) on multivariate analysis with adjustment for female sex and both-bone diaphyseal fracture. Both-bone diaphyseal fracture (ICD-10 code S52.4) had an OR of 9.01 (95% CI, 4.86 to 17.37) on univariate analysis and an OR of 9.98 (95% CI 5.32 to 19.47) on multivariate analysis with adjustment for age and female sex. Overall, 777 fractures were internally fixed. The risk of nerve injury as a complication of internal fixation was 1.3% (10 of 777). Four of these iatrogenic injuries (including 2 involving the median nerve, 1 involving the ulnar nerve, and 1 involving the radial nerve) were permanent; thus, the risk of permanent nerve injury as a complication of internal fixation was 0.5% (4 of 777).Conclusions: Nerve injury following a pediatric forearm fracture is rare and has an excellent potential for spontaneous recovery. In the present study, all of the permanent nerve injuries occurred in association with open fractures or as a complication of internal fixation.

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Functional outcome of synchronous tendon transfer of pronator teres to ECRB with primary nerve repair in high radial nerve injury

Ahmed¹,

Sakka²,

Hassan³

et al. 2023

Eur J Plast Surg

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Primary radial nerve palsy associated with humeral shaft fractures according to injury mechanism: is early exploration needed?

Cited by 5 publications

References 25 publications

Conservative Management with Functional Brace Versus Various Surgical Fixation Techniques for Humeral Shaft Fractures

Conservative Management with Functional Brace Versus Various Surgical Fixation Techniques for Humeral Shaft Fractures

The Risk of Nerve Injury in Pediatric Forearm Fractures

Functional outcome of synchronous tendon transfer of pronator teres to ECRB with primary nerve repair in high radial nerve injury

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