Treatment of Iatrogenic Nerve Injury After Humeral Shaft Fracture Fixation: A Case Report

Abstract

Background. Iatrogenic radial nerve palsy after interlocking intramedullary nailing in fractures of the femoral shafts occurs in 2.9% of patients. At the same time, in 30% of cases, iatrogenic radial nerve injury is associated with distal blocking of the pin. The question, concerning the timing and scopes of diagnostic studies to determinate the character of nerve damage, methods of conservative and surgical treatment, and its effectiveness still remains open.
 Clinical case. A 30-year-old patient was treated in the N.V. Sklifosovsky Research Institute for Emergency Medicine with an non-union fracture of the left humerus and iatrogenic radial nerve palsy after 3 months after interlocking intramedullary nailing in another hospital. Repeated operative intervention was performed by removal of the pin from the left humerus, rheosteosynthesis of the left humerus with a plate, revision, neurolysis, plastic surgery of the left radial nerve with autografts of the right calf nerve. Courses of drug therapy, physiotherapy, therapeutic gymnastics were carried out.
 Results. After 26 months we observed the full amplitude and restoration of the strength of active extension of the left hand and long fingers, retraction of the first finger, incomplete amplitude of extension of the 1st finger, restoration of sensitivity on the outer surface of the left forearm and the back surface of the hand.
 Conclusion. Iatrogenic radial nerve palsy occurs mainly as a result of non-adequate technique of inserting locking screws when osteosynthesis of fractures of the humerus diaphysis with pins is carried out. Late examination and surgical treatment of patients with a damaged radial nerve leads to a lack of early functional recovery, potential muscle atrophy and inhibition of their motor function. Operative interventions aimed at restoring the radial nerve integrity in the early stages after injury, combined with a full range of postoperative rehabilitation during the year, can be an alternative to orthopedic surgery.