Incidence Of Iatrogenic Nerve Palsy Research Articles

The standardized exploration of the radial nerve during humeral shaft fixation reduces the incidence of iatrogenic palsy.

The purpose of this study is to determine if a standardized protocol for radial nerve handling during humeral shaft repair reduces the incidence of iatrogenic nerve palsy post operatively. Seventy-three patients were identified who underwent acute or reconstructive humeral shaft repair with radial nerve exploration as part of the primary procedure for either humeral shaft fracture or nonunion. All patients exhibited intact radial nerve function pre-operatively. A retrospective chart review and analysis identified patients who developed a secondary radial nerve palsy post-operatively. In each case, the radial nerve was identified and mobilized for protection, regardless of whether the implant necessitated the extensile exposure. Fractures were classified according to AO/OTA guidelines and included 23 Type 12A, 11 Type 12B, and 3 Type 12C. Eight patients had periprosthetic fractures and 28 fractures could not be classified. All patients in the cohort were fixed with locking plates. Surgery was indicated for 36 patients with humeral nonunions and 37 patients with acute humeral shaft fractures. Of the 73 patients, 2 (2.7%) developed radial nerve palsy following surgery, one from the posterior approach and one from the anterolateral approach. Both patients exhibited complete recovery of radial nerve function by 6-month follow-up. No significant differences (p > 0.05) were found in any demographic or surgical details between those with and without radial nerve injury. Nerve exploration identification and protection leads to a low incidence of transient radial nerve palsy compared to the rate reported in the current literature (2.7% compared to 6-24%). Thus, radial nerve exploration and mobilization should be considered when approaching the humeral shaft for acute fracture and nonunion repairs. Level III.

Humeral shaft fractures: results of operative and non-operative treatment.

There has been little direct comparison between non-operative and operative management of humeral shaft fractures. The present study aimed to compare union rates and complication rates between these two modalities of treatment. A retrospective cohort study was performed at a regional level 1 trauma centre. A total of 296 patients with humeral shaft fractures met inclusion criteria; 69 patients were treated with a functional brace and 227 with surgical intervention. The primary end point was radiographic union. Nonunion was defined as failure of radiological union at sixmonths, requiring surgical intervention. Time to union, nerve palsy rate, and rate of infection were also examined. The nonunion rate was significantly higher in the non-operative group (23.2% vs 10.2%) despite higher rates of open fractures and high energy mechanisms of injury in the operative group. No significant difference in time to union was found. Nerve palsy was more common in the operative group (20% vs 39%); however, only two cases (1%) of radial nerve palsy in the operative group were iatrogenic and both were transient. Infection rates were higher for the operative group (3.5% vs 0%). Conservative treatment of humeral shaft fractures has a higher rate of nonunion, while operative treatment is associated with a low incidence of iatrogenic nerve palsy but higher rates of infection.

Operative treatment of displaced acetabular fractures: a systematic review

Objective To systematically review the published articles available on management for the displaced acetabular fractures. Methods MEDLINE, EMBASE, CBM and Cochrane Database were searched for the articles on management of displaced acetabular fractures in the past 40 years. Manual searches of the bibliographic sections of electronically identified papers were done to identify further papers. Meticulous data extraction and meta-analysis were performed according to preset protocol. Results Of 869 citations initially identified, 72 papers which involved a total of 6509 patients with 6549 acetabular fractures met all eligibility criteria. Reduction was anatomical or good in 87.6% of the patients, and poor in 13.0%. An incidence of iatrogenic nerve palsy was 6.0%. Deep venous thrombosis (DVT) and pulmonary embolism (PE) had an overall incidence of 3.9%. The incidence of local wound infections was 4. 2%. The heterotopic ossifi-cation (HO) was seen in 26.9% of the patients. The overall incidence of osteoarthritis (OA) was 18.0%. The score to assess the functional results, 46.6% of the patients were graded as excellent, 32.4% as good, 11.6% as fair, and 9. 5% as poor. Using the Harris Hip Score (HHS), 48.4% of the patients had an ex-cellent result, 26.9% were graded as good, 10.7% as fair, and 14.0% as poor. 85.5% of the patients with satisfactory reduction had an excellent or good functional result, while 63.7% of the patients without satis-factory reduction did. The most common cause was road traffic accident. The most common fracture types were fractures of the posterior wall and both columns as well as transverse ones associated with posterior wall. Conclusions Operative management of displaced acetabular fractures can have satisfactory functional out-comes. Reduction quality may be the major influence on functional outcome. The most common long-term complications are osteoarthritis and heterotopic ossification. Key words: Acetabulum; Fracture; Fracture fixation, internal; Evaluation studies