The radial nerve at revision/redo surgery – using the lower lateral cutaneous nerve to prevent a postoperative radial nerve deficit

Abstract

The posterior approach to the humeral shaft is commonly used for surgical procedures on the humeral shaft. We present our experiences using the modification of the surgical exposure described by Gerwin M. which we have found useful at the time of revision surgery. Between 2014 and 2019, six patients who underwent a revision surgical procedure for a nonunion of the humeral shaft where a prior surgical procedure was performed through a posterior incision were included. The approach used a modification of the posterior approach described byGerwin M. where the lower lateral cutaneous nerve branch of the radial nerve is used to identify trace, mobilize, retract, and protect the radial nerve to achieve adequate exposure of the humeral shaft. None of the patients had a postoperative nerve deficit.Adequate exposure to aid hardware removal, osteosynthesis, and bone grafting was achieved in all patients. The modification of the posterior approach described by Gerwin M. is useful at the time of revision or redo surgery on the humeral shaft where other bony and soft tissue landmarks are altered to prevent an iatrogenic injury to the radial nerve while providing adequate exposure to treat a nonunion.