The Effect of Humerus Diaphyseal Shortening on Brachial Plexus Tension: A Cadaver Study

Andrzejewski, Aurélie; Moungondo, Fabian; Feipel, Véronique; Rooze, Marcel; Schuind, Frédéric

doi:10.1016/j.jhsa.2014.10.059

Cited by 4 publications

(14 citation statements)

References 24 publications

(16 reference statements)

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“…the scapular notch and the axillary nerve around the surgical neck of the humerus. As in the study of Andrzejewski et al (2015), we observed that one specimen had a very distal piercing of the coracobrachialis by the musculocutaneous nerve, allowing for greater gains in nerve lengths. If humeral shortening is used in clinical practice, preoperative magnetic resonance imaging or sonography of the musculocutaneous nerve could be helpful in identifying this beneficial anatomical variant.…”

Section: Humeral Shorteningsupporting

confidence: 57%

“…When the nerve pierces the muscle close to the coracoid process, which is the usual situation, an intramuscular neurolysis could possibly be helpful, but with the risk of injuring some proximal motor branches. In contrast, the study of Andrzejewski et al (2015) concluded that the gain of plexus length obtained by a 6 cm humeral shortening was modest, not exceeding a mean of 17 mm. In their study, the plexus appeared quite slack, fixed at the level of the axillary crease, and it seemed that under a modest traction, a further gain of length could be obtained.…”

Section: Humeral Shorteningmentioning

confidence: 91%

“…In fact, even between right and left sides of the same donor, no plexus was the same. For reasons of exposure and for the specimens to be in the same conditions as in the study of Andrzejewski et al (2015), the arm was maintained throughout the experiment in 90 abduction. This kept the coracobrachialis under tension, which contributed to fixing the musculocutaneous nerve.…”

Section: Humeral Shorteningmentioning

confidence: 99%

“…Elbow flexion was not significantly altered by humeral shortening. An anatomical study by Andrzejewski et al (2015) demonstrated that humeral shortening caused relaxation of the brachial plexus and of the musculocutaneous, median and ulnar nerves, but not of the radial nerve. The nerves, which are relatively fixed in place by their branches, tended to remain in the axilla and did not appear to retract towards the supraclavicular region.…”

Section: Introductionmentioning

confidence: 99%

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Effects of humeral shortening on the three-dimensional configuration of the brachial plexus: a cadaveric study

Valcarenghi

Moungondo

Andrzejewski

et al. 2019

J Hand Surg Eur Vol

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This study reports the gains in length of nerves after three different humeral shortenings. Ten brachial plexuses were dissected. The lengths of the different parts of the brachial plexus were measured using a three-dimensional digitizing system after humeral shaft shortenings of 2, 4 and 6 cm and after a standardized force of 0.588 N was used to apply tension to the plexus. The feasibility of nerve suturing was studied. Humeral shortening allowed for significant gains in lengths of the musculocutaneous (42 mm), median (41 mm), ulnar (29 mm) and radial nerves (15 mm). A 2 cm humeral shortening allowed a 2 cm nerve gap to be directly sutured in 70% to 90% of cases. This study suggests that humeral shortening could allow direct suture of nerve defects, or shorten the length of nerve grafts required to bridge a gap.

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Section: Humeral Shorteningsupporting

confidence: 57%

Section: Humeral Shorteningmentioning

confidence: 91%

Section: Humeral Shorteningmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of humeral shortening on the three-dimensional configuration of the brachial plexus: a cadaveric study

Valcarenghi

Moungondo

Andrzejewski

et al. 2019

J Hand Surg Eur Vol

Self Cite

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show abstract

“…Acute shortening osteotomy has been suggested to facilitate nerve transfer with primary anastomosis and avoid nerve grafting 15,77,78 . Primary repair has long been the gold standard and is preferable over both autograft and allograft due to greater rates of axonal recovery 8,10,12,15,101,102 . Direct coaptation is at least equally effective and more straightforward than transfers involving interpositional grafts 10 .…”

Section: Neural Repairmentioning

confidence: 99%

Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature

Kusnezov

Dunn

et al. 2015

Orthopaedic Surgery

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In the setting of near or complete upper extremity amputations with significant soft tissue loss and neurovascular compromise, upper extremity surgeons are faced with the challenge of limb salvage. There are a multitude of treatment options for managing skeletal and soft tissue injuries including provisional fixation, staged reconstruction, and an acute shortening osteotomy with primary rigid internal fixation. However, many complications are associated with these techniques. Complications of provisional fixation include pin tract infection and loosening, tethering of musculotendinous units, nonunion, and additional surgeries. Staged reconstruction includes a variety of techniques: distraction osteogenesis, bone transport, or vascularized and non-vascularized structural autograft or allograft, but the risks often outweigh the benefits. Risks include nonunion, postoperative vascular complications necessitating reoperation, and the inability to return to the previous level of function at an average of 24 months. Acute shortening osteotomy with internal fixation offers the advantage of a single-stage procedure that provides for decreasing the soft tissue loss, provides a rigid platform to protect the delicate neurovascular repair, and alleviates unwanted tension at the repair sites. This review discusses the literature on the surgical treatment of severe upper extremity trauma with associated neurovascular injury over the past 75 years, and aims to evaluate the indications, surgical techniques, clinical and functional outcomes, and complications associated with acute shortening osteotomy with rigid internal fixation. Although this technique is not without risks, it is well-tolerated in the acute setting with a complication profile comparable to other techniques of fixation while remaining a single procedure.

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Der kontralaterale C7 Transfer

Bahm,

Beier,

Schäfer

2024

Handchir Mikrochir Plast Chir

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ZusammenfassungKomplexe Verletzungen des Plexus brachialis mit multiplen oder vollständigen Ausrissen der Wurzeln machen in einigen Fällen eine Rekonstruktion unter Verwendung intraplexaler Spendernerven unmöglich. In solchen Fällen ist es erforderlich, dass man sich extraplexischer Nervenspender bedient, wie beispielsweise des N. accessorius oder der Intercostalnerven. Die kontralaterale C7-Wurzel stellt einen Spender mit einer hohen Axonzahl dar, die in solchen Fällen als Axonquelle herangezogen werden kann. Wir beschreiben die aktuelle Indikationsstellung, Operationstechnik und funktionelle Resultate nach einem kontralateralem C7-Transfer bei Plexusläsionen der oberen Extremität anhand eigener Fallbeispiele und einer spezifischen Literaturrecherche.

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The Effect of Humerus Diaphyseal Shortening on Brachial Plexus Tension: A Cadaver Study

Cited by 4 publications

References 24 publications

Effects of humeral shortening on the three-dimensional configuration of the brachial plexus: a cadaveric study

Effects of humeral shortening on the three-dimensional configuration of the brachial plexus: a cadaveric study

Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature

Der kontralaterale C7 Transfer

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