Time From Injury to Surgical Fixation of Diaphyseal Humerus Fractures Is Not Associated With an Increased Risk of Iatrogenic Radial Nerve Palsy

Shoji, Kristin; Heng, Marilyn; Harris, Mitchel B.; Appleton, Paul; Vrahas, Mark; Weaver, Michael J.

doi:10.1097/bot.0000000000000875

Cited by 19 publications

(7 citation statements)

References 18 publications

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“…e difficulty in an anatomical reduction in the delayed group may explain our result of a higher delayed union rate. Meanwhile, the incidence of iatrogenic radial nerve injuries did not differ significantly between the early and delayed groups in this study; this is analogous to a previously reported finding that delayed intervention for humeral shaft fractures did not increase the risk for radial nerve palsy [4]. e rate of postoperative infection in this study was 2.3%, which was similar to the rate of 3-5% reported in previous studies [10,11].…”

Section: Discussionsupporting

confidence: 90%

“…Surgical treatment of humeral shaft fractures has been reported to yield relatively satisfactory results compared to conservative treatment; however, there are complications, such as delayed bone union, nonunion, iatrogenic radial nerve injury, and infection [1][2][3]. To date, little has been reported on the factors affecting postoperative complications of humeral shaft fractures [3,4]. Furthermore, the effects of the timing of surgery on the clinical outcomes for acute humeral shaft fractures remain unsolved.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Timing on Surgical Outcomes for Acute Humeral Shaft Fractures

Furuhata

Kamata

Kono

et al. 2021

Advances in Orthopedics

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Surgical treatment for humeral shaft fractures has been reported to yield satisfactory results; however, there may be complications, such as delayed bone union, nonunion, iatrogenic radial nerve injury, and infection. The risk factors for postoperative complications remain largely unknown. This study aimed to investigate the influence of timing of surgery on the incidence of postoperative complications of acute humeral shaft fractures. We retrospectively reviewed 43 patients who underwent osteosynthesis for acute humeral shaft fractures between 2006 and 2020. The patients were divided into early (21 patients) and delayed (22 patients) treatment groups based on the timing of the surgical intervention (within or after four days). Outcomes were the incidences of complications (delayed union, nonunion, iatrogenic radial nerve injury, and infection) and postoperative fracture gaps. We evaluated the outcomes using plain radiographs and clinical notes. In addition, we performed subgroup analyses on outcomes in a subgroup of patients who underwent intramedullary nailing and one who underwent plate fixation. The frequency of delayed union was significantly higher in the delayed group ( P = 0.046 ), and the postoperative fracture gap size was also significantly greater in the delayed group ( P = 0.007 ). The subgroup analyses demonstrated a significant association between the increased incidence of delayed union and delayed surgical interventions only in the intramedullary nailing subgroup ( P = 0.017 ). This study suggests that performing surgery within four days after acute humeral shaft fracture is recommended to reduce the occurrence of delayed union, particularly in cases requiring intramedullary nailing fixation.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Influence of Timing on Surgical Outcomes for Acute Humeral Shaft Fractures

Furuhata

Kamata

Kono

et al. 2021

Advances in Orthopedics

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“…The position of the patient during general anesthesia is also a causative factor as loss of muscle tone can lead to inadvertent traction at the fracture site and compression of the radial nerve [ 13 ]. For the most part, radial nerve entrapment is seen after fracture manipulation when the nerve is unknowingly entrapped between bone and an installed plate, compressed by a bone fragment or if excessive nailing of the bone occurs [ 14 ]. A study concluded that in 78% of patients suffering from iatrogenic radial nerve palsy, the injury occurred after a plate osteosynthesis approach.…”

Section: Reviewmentioning

confidence: 99%

Injury of the Radial Nerve in the Arm: A Review

Latef¹,

Bilal²,

Vetter

et al. 2018

Cureus

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Compression of the radial nerve is most commonly described at the supinator muscle (i.e., arcade of Frohse). However, radial nerve compression can occur in the arm. Therefore, the purpose of this article is to review both etiologies of radial nerve entrapment and the sites at which this can occur in the arm. The clinical presentation of radial nerve entrapment in the arm and how it differs from that of entrapment at other sites is reviewed and the conditions potentially predisposing to nerve entrapment are described. Particular attention is paid to the nerve’s course and potential variants of the anatomical structures in the arm. In each case, the recommended course of management for the neuropathy is described. Injury of the radial nerve can arise from a varied set of pathologies including trauma, tumors, anomalous muscles, and intramuscular injections. Physicians should have a good working knowledge of the anatomy and potential mechanisms for radial nerve injury.

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“…Ятрогенные повреждения лучевого нерва при хирургическом лечении диафизарных переломов плечевой кости возникают, по разным данным, в 8-19% случаев [1][2][3]. Такие повреждения часто (до 46% случаев) сопровождаются продолжительными, до 9-14 месяцев, двигательными и чувствительными расстройствами [4].…”

Section: Introductionunclassified

“…Терапевтическое лечение нейропатии после выполненной ревизии лучевого нерва не обсуждается в зарубежных профильных публикациях [3,8,12], а в работах отечественных авторов отсутствует единство взглядов на такое лечение [4,5,11,[22][23][24].…”

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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Time From Injury to Surgical Fixation of Diaphyseal Humerus Fractures Is Not Associated With an Increased Risk of Iatrogenic Radial Nerve Palsy

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 19 publications

References 18 publications

Influence of Timing on Surgical Outcomes for Acute Humeral Shaft Fractures

Influence of Timing on Surgical Outcomes for Acute Humeral Shaft Fractures

Injury of the Radial Nerve in the Arm: A Review

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

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