Fracture-Associated Nerve Dysfunction

Abstract

juries (3%), with 95% of patients having associated fractures. Most patients were young (average of 35 years of age), male (83%), and injured in a motor vehicle accident (51%). The upper extremity was involved 61% of the time, with the radial nerve the most frequently injured (29%). Specifically, in humerus fractures, the incidence of radial, ulnar, and median nerve injuries were 9.5%, 3.8%, and 1.4%, respectively. For radius/ulnar fractures, the incidence of nerve injury was 2.6%, 2.4% and 1.3%, respectively. The grade (using the Sunderland classification) was ascertained in 196 of the 200 nerve injuries, and the functional outcome was measured in 125 patients, with an average of 300 days follow-up. Of 196 patients, 44 (22%) had grade 1 injuries, with 97% of patients having full recovery and 3% having good recovery. A total of 66 (34%) had grade 2 injuries and had mostly good to normal outcome. Thirty-eight patients (19%) had grade 3 and grade 4 injuries with variable results and 48 patients (24%) had grade 5 injuries with poor functional outcome. These injuries include both open and closed fractures and were generally high-energy injuries. 1 Commonnerveinjury‐fractureassociations Shoulderdislocations/fracturesandaxillarynerveinjury: Theonly prospective study, to our knowledge, evaluating fracture-associated nerve injuries evaluated neuropathies after primary shoulder dislocations and proximal humerus fractures. In that study, de Laat et al. found that 45% of 101 patients had evidence of nerve injury by clinical and electrophysiologic testing. 2 The axillary nerve (37%) was the most commonly injured, followed by the suprascapular (29%), radial (22%), musculocutaneous (19%), and ulnar (9%) nerves, respectively. Of those patients, 36 (80%) were older than 65 years of age. Four months after injury, only 8 patients had persistent motor dysfunction. Among those 8 patients, at 8