Therapeutic Approach to Humeral Bone Fractures Complicated by Peripheral Nerve Trauma

Neverov, V A; Chernyaev, S. N.; Shinkarenko, D. V.

doi:10.24884/0042-4625-2015-174-6-42-45

Cited by 2 publications

(1 citation statement)

References 4 publications

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“…Ятрогенные нейропатии могут быть связаны с применением как внешней фиксации [2,8], так и погружного остеосинтеза [9,10]. Причины повреждений обусловлены прямым и непрямым воздействием на нерв -ранением, тракцией, компрессией и контузией, или их сочетанием.…”

Section: Introductionunclassified

Iatrogenic Damage to the Radial Nerve During Osteosynthesis of the Humerus. Prevention, Diagnosis and Treatment

Bogolyubsky¹,

Fayn²,

Sachkov³

et al. 2020

Neotložnaâ med. pomoŝʹ

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THE RELEVANCE is determined by the significant frequency of iatrogenic injuries of the radial nerve during internal osteosynthesis of the humerus, long-lasting functional disorders, a large number of unsatisfactory results, as well as the lack of a unified approach to diagnosis and treatment.MATERIAL AND METHODS. The causes of iatrogenic damage to the radial nerve were studied in 22 patients who underwent internal fixation during fractures of the humeral diaphysis. The ultrasound examination was used to visualize the radial nerve. In 13 patients (59.1%), a pathogenetic treatment was used, including medication, physical and mechanical therapy.RESULTS AND DISCUSSION. In plate osteosynthesis, a greater number of iatrogenic damage to the radial nerve was observed than during osteosynthesis with screws. The ultrasound method had high diagnostic values to determine the continuity of the nerve trunk and identify conflicts with solid structures. The use of pathogenetic therapy of neuropathy led to a more rapid clinical recovery of limb function.CONCLUSION. To prevent iatrogenic injuries and avoid gross manipulations, the access with sufficient visualization of the radial nerve is necessary in plate osteosynthesis and distal blocking outside the projection of the radial nerve is necessary in intramedullary osteosynthesis. Indications for early revision after iatrogenic damage are neurotmesis and a nerve conflict with bone fragments or an implant.

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Section: Introductionunclassified

Iatrogenic Damage to the Radial Nerve During Osteosynthesis of the Humerus. Prevention, Diagnosis and Treatment

Bogolyubsky¹,

Fayn²,

Sachkov³

et al. 2020

Neotložnaâ med. pomoŝʹ

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Unstable Osteosynthesis of a Humeral Diaphyseal Fracture as a Cause of a Pseudoarthrosis and an Extensive Bone Defect (A Case Report)

Bragina

Iskusov

Lapidus

et al. 2020

Traumatology and Orthopedics of Russia

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Relevance. The causes of the formation of a humeral diaphyseal pseudarthrosis can be various risk factors and their combination, including iatrogenic, associated with osteosynthesis technique non-compliance. This leads to instability of the metal constructions with the destructive consequences for the bone tissue and the injured limb function in general. Case presentation. A 60-year-old woman received a right humeral diaphyseal fracture with displacement (АО/АSIF 12-A3) and underwent locking intramedullary osteosynthesis. Subsequently, the fixation failure developed. In 3 years after the primary surgery, a combination of two complications was diagnosed: a nonunion and a defect of the humerus with the formation of a traumatic bone cyst in the distal part. The patient was reoperated: resection of the pseudarthrosis, removal of the right humerus cyst, and revision plate osteosynthesis with bone autografting. A positive result of treatment was obtained: fracture consolidation, reparation of the distal humerus bone structure and restoration of the right upper limb function. Conclusion. The presented clinical case demonstrates the importance of careful preoperative planning of osteosynthesis: the selection of an appropriate implant size, and adequate intraoperative blocking of the intramedullary nail to create a stable “bone-fixator” system. The careful outpatient follow-up of the patient, early detection of possible complications and timely surgical removal of the unstable implant with revision osteosynthesis are required.

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Therapeutic Approach to Humeral Bone Fractures Complicated by Peripheral Nerve Trauma

Abstract: On the basis of treatment results of 28 patients, the authors suggested that the clinical method of diagnostics allowed performance of topical diagnostics of injury using bedside test. It would help to choose a therapeutic approach in each clinical case.

Cited by 2 publications

References 4 publications

Iatrogenic Damage to the Radial Nerve During Osteosynthesis of the Humerus. Prevention, Diagnosis and Treatment

Iatrogenic Damage to the Radial Nerve During Osteosynthesis of the Humerus. Prevention, Diagnosis and Treatment

Unstable Osteosynthesis of a Humeral Diaphyseal Fracture as a Cause of a Pseudoarthrosis and an Extensive Bone Defect (A Case Report)

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