Surgical Treatment of Radial Nerve Injuries Associated With Humeral Shaft Fracture-A Single Center Experience.

Lukas Rasulić,Andrija Savić,Aleksa Mićić,Miloš Maletić,Vladimir Puzović,Milan Lepić,Jovan Grujić,Stefan Radojević,Slavko Djurašković,Stefan Mandić-Rajčević,Novak Lakićević

doi:10.3389/fsurg.2021.774411

Abstract

Radial nerve injuries are often associated with humeral shaft fractures. The results of treatment of these injuries, by contemporary surgical approaches, remain diverse. In this paper we presented the outcomes and analyzed the patient, clinical, and surgical procedure related characteristics and factors that may influence the outcome overall, in 77 patients treated at Clinic for Neurosurgery, Clinical Center of Serbia during a 20 years period. The nerve injuries were verified by US and EMNG. The majority of patients were treated by neurolysis or sural nerve grafting, while only few were treated by direct suture. The final recovery was evaluated by muscle strength assessment and classified using MRC. We analyzed extension of the wrist, extension of the fingers including the thumb, and abduction of the thumb. There was a significant statistical difference in MRC grade following the treatment. The total rate of useful functional recovery was achieved in 69 (89.61%) out of all studied patients, out of whom 20 (28.99%) achieved excellent recovery, 26 (37.68%) achieved good recovery and 23 (33.33%) achieved fair recovery. Only 8 (10.39%) out of all studied patients achieved poor recovery. The injured nerves, that were preserved in continuity, acquired by a low-energy trauma, and treated earlier than the 6 months were associated with better functional outcome following the surgery. In addition, there was a trend of better functional improvement with aging, keeping in mind that the old were subjected to lower energy trauma. The expectant management followed by surgery of radial nerve injury associated with humeral shaft fracture should be around 3 months, and the surgical nerve repair should not be performed later than the 6 months after injury. The energy of trauma may be a factor predicting patient's final recovery following the treatment.

Highlights

The fractures of the humeral shaft make up about 1–3% of all skeletal fractures, and belong to the group of the most common bone injuries [1,2,3,4]
The final recovery was evaluated by muscle strength assessment and classified using muscle strength scaling system (MRC)
The vary fact that more than a half of radial nerve lesions treated at our clinic during the last 20 years were associated with humeral shaft fracture, indicates the importance of this particular entity

Summary

Introduction

The fractures of the humeral shaft make up about 1–3% of all skeletal fractures, and belong to the group of the most common bone injuries [1,2,3,4]. Despite the fact that the fracture repair is usually successful [23, 24], the injury to the radial nerve can leave permanent functional disability of the hand (wrist drop) and sequentially the arm as a whole [20] This loss of hand function is found to be a horrifying experience for the majority of patients [25], and the fact that most of the patients contribute significantly to the household and the community further exacerbates their own and their families suffering [26,27,28] and presents a big socioeconomic issue [25, 29, 30]

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