Incidence Of Radial Nerve Palsy Research Articles

Nonoperative Treatment of Humeral Shaft Fractures With Immediate Functional Bracing Versus Coaptation Splinting and Delayed Functional Bracing: A Retrospective Study.

To compare radiographic and clinical outcomes in nonoperative management of humeral shaft fractures treated initially with coaptation splinting (CS) followed by delayed functional bracing (FB) versus treatment with immediate FB. Retrospective cohort study. Academic Level 1 Trauma Center. Patients with closed humeral shaft fractures managed nonoperatively with initial CS followed by delayed FB or with immediate FB from 2016 to 2022. Patients younger than 18 years and/or with less than 3 months of follow-up were excluded. The primary outcome was coronal and sagittal radiographic alignment assessed at the final follow-up. Secondary outcomes included rate of failure of nonoperative management (defined as surgical conversion and/or fracture nonunion), fracture union, and skin complications secondary to splint/brace wear. Ninety-seven patients were managed nonoperatively with delayed FB (n = 58) or immediate FB (n = 39). Overall, the mean age was 49.9 years (range 18-94 years), and 64 (66%) patients were female. The immediate FB group had less smokers ( P = 0.003) and lower incidence of radial nerve palsy ( P = 0.025), with more proximal third humeral shaft fractures ( P = 0.001). There were no other significant differences in demographic or clinical characteristics ( P > 0.05). There were no significant differences in coronal ( P = 0.144) or sagittal ( P = 0.763) radiographic alignment between the groups. In total, 33 (34.0%) humeral shaft fractures failed nonoperative management, with 11 (28.2%) in the immediate FB group and 22 (37.9%) in the delayed FB group ( P = 0.322). There were no significant differences in fracture union ( P = 0.074) or skin complications ( P = 0.259) between the groups. This study demonstrated that nonoperative treatment of humeral shaft fractures with immediate functional bracing did not result in significantly different radiographic or clinical outcomes compared to treatment with CS followed by delayed functional bracing. Future prospective studies assessing patient-reported outcomes will further guide clinical decision making. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Radial nerve transection after ballistic humeral shaft fractures: A retrospective cohort study

IntroductionRadial nerve palsy following fracture of the humeral shaft is common. However, the incidence of nerve transection in the setting of ballistic trauma is unknown. The purpose of this study was to estimate the incidence of radial nerve transection after ballistic fracture of the humerus. MethodsPatients presenting to an urban, level-1 trauma center with a ballistic fracture of the humeral shaft were retrospectively reviewed. Patient demographics, clinical exam on presentation, and operative data were reviewed to determine the incidence of radial nerve palsy on initial examination, the incidence of operative treatment, the incidence of how frequently the nerve was directly visualized, and the incidence of radial nerve transection. ResultsOne-hundred and thirteen ballistic humeral shaft fractures were identified. Of these, 30 (26.5%) patients had a complete radial nerve palsy on exam. Of patients with a radial nerve palsy, on exam 20 were taken to the operating room and the nerve was visualized in 17 of those cases. There 2 were partially lacerated nerves and 12 nerves were completely transected. Thus, in patients with a complete nerve deficit on examination who underwent operative treatment with nerve exploration, the rate of nerve transection was 70.6%. The lower bound rate of nerve transection for all patients with radial nerve palsy (assuming all unexplored nerves were intact) was 40.0%. ConclusionThe rate of nerve transection in patients with humerus shaft fractures with associated radial nerve palsies is likely higher than the rate of nerve transection in similar injuries caused by blunt mechanisms. The authors recommend early exploration and fixation of these injuries.

Small-Fragment Plate Fixation of Humeral Shaft Fractures.

Fixation of humeral shaft fractures is frequently performed with large-fragment (4.5 mm) plates to accommodate immediate weight bearing. Use of small-fragment (3.5 mm) plates as an alternative carries theoretical benefits. We examined nonunion rates and postoperative radial nerve palsy (RNP) rates in a retrospective cohort of patients undergoing open reduction and internal fixation of humeral shaft fractures with 3.5-mm or 4.5-mm plates. Two hundred thirty-six patients with 241 humeral shaft fractures were included. Small 3.5-mm plates were used in 83% of the patients, and large 4.5-mm plates were used in 17% of the patients. Fifty-three percent were made weight bearing as tolerated following surgical fixation. There was a 7% incidence of nonunion and a 10% incidence of RNP in the 3.5-mm plate group. There was a 7% incidence of nonunion and a 15% incidence of RNP in the 4.5-mm plate group. No statistically significant relationship was shown between nonunion or RNP and plate size (P=.74 and P=.39). No relationship was shown between nonunion and postoperative weight-bearing status (P=.45). Subgroup analysis according to plate size additionally showed no association of nonunion with postoperative weight bearing in both the 4.5-mm (P=.55) and the 3.5-mm (P=.25) cohorts. Small-fragment and large-fragment plating of humeral shaft fractures resulted in comparable union and RNP rates, regardless of postoperative weight-bearing status. Our findings suggest that 3.5-mm plate fixation of humeral shaft fractures is a safe alternative to 4.5-mm plate fixation. [Orthopedics. 2023;46(4):198-204.].

Intramedullary Nailing Versus Plate Fixation for Humeral Shaft Fractures: A Systematic Review and Meta-Analysis.

The two techniques most utilized in the surgical treatment of humeral shaft fractures are open reduction internal fixation (ORIF) and intramedullary nailing (IMN). Although there have been multiple comparative clinical studies comparing outcomes for these two treatments, studies have not suggested one approach to be superior to the other. The purpose of this study is to perform a systematic literature review and meta-analysis of studies that evaluated the treatment of humeral shaft fractures with either ORIF or intramedullary nail. We conducted this meta-analysis utilizing stricter inclusion and broader exclusion criteria to examine these two common approaches. We examined those articles which have compared first-time, closed fractures of the humeral diaphysis in adults in fracture patterns that could be treated equivalently by intramedullary nail or plate fixation. The primary outcome of interest was nonunion, and studies that did not report nonunion rates were excluded. There were a total of 1,926 abstracts reviewed and a total of three articles were included in the final analysis after screening. There was no significant difference in the incidence of nonunion between plating (2/111, 1.8%) and nailing (4/104, 3.9%) (P>0.05). The mean difference in average time to union for plated fractures and nailed fractures was 1.11 weeks (95% CI 0.82 to 1.40) which was statistically significant (P<0.05). There was a significant difference in the incidence of radial nerve palsy (12/111, 10.8%) for plating compared to nailing (0/104, 0%) (P=0.0004). There was no difference in incidence of post-operative infection between the two groups intramedullary nailing (P>0.05). The results of this analysis demonstrate an increased risk of iatrogenic radial nerve injury, and a significantly shorter time to union when treating humeral shaft fractures with plating as compared to intramedullary nailing. There was no difference in the rates of nonunion or delayed union. Based on the evidence, both plating and nailing can achieve a similar treatment effect on humeral shaft fractures.

Relationship between incidence of postoperative radial nerve palsy and surgical experience in the treatment of humeral shaft fractures through a posterior triceps splitting approach: A retrospective study.

The aim of this study was to investigate the incidence of postoperative radial nerve palsy (PORNP) after the surgical treatment of humeral shaft fractures through a posterior triceps splitting approach by a single surgeon's experience in a consecutive case series from a single trauma center. In this retrospective study, a total of 118 patients (82male, 36 female;mean age = 48 years, age range = 16 - 80 years)who underwent open reduction and plate fixation through posterior triceps splitting approach due to humeral shaft fractures at a level I trauma center were included. Level of the fractures was categorized as the proximal third, middle third, and distal third of the diaphysis, and then all the fractures were classified according to the AO/OTA classification system. The trend of incidence of PORNP was investigated. All the operations were performed by a single surgeon. The recovery time of PORNP was also recorded. There were 13 cases of proximal third, 67 cases of middle third, and 38 cases of distal third fracture. Based on AO/OTA classification, there were 29 cases of A1-type, 23 cases of A2-type, 42 cases of A3-type, 17 cases of B2-type, 3 cases of B3-type, and 4 cases of C2-type fracture. The overall incidence of PORNP was 11% (13 cases). All the PORNP cases fully recovered within 10.3 ± 10.4 weeks (range = 1 - 44) with conservative treatment. Incidence of PORNP significantly decreased with increase in surgical experience (P = 0.009). The incidence of radial nerve palsy was not significantly related to the level of the fracture (P = 0.199). The incidence of radial nerve palsy was not significantly related with the fracture pattern according to AO/OTA classification (P = 0.659). Evidence from this study has shown that the incidence of PORNP following the posterior triceps splitting approach for the treatment of humeral shaft fractures is significantly associated with the surgeon's experience. Level IV, Therapeutic Study.

Fixation of Middle Third Humeral Shaft Fractures by Anteromedial Plate Through Anterolateral Approach

AbstractBackground: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in antero-medial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure.Aim of Study: The aim of this study is evaluation of results of fixation of middle third of humeral shaft fractures by anteromedial plate osteosynthesis through an anterolateral approach.Patients and Methods: In this prospective study, 21 cases with middle third humeral shaft fractures were treated with anteromedial plate through anterolateral approach. Clinical and radiological data were analyzed.Results: These cases were assessed according to Murphy scoring systems for middle third humerus fracture the clinical results were graded as excellent in 14 patients (66.6%), good in4 patients (19%), fair in 3 patients (14.3%) & poor in no patients (0%). The excellent and good results were considered as satisfactory results, while the unsatisfactory included the fair and the poor results. Thus, satisfactory results were found in 18 patients (85.7%), and the unsatisfactory results were found in 3 patients (14.3%).Conclusion: This study proves that anteromedial plating of middle shaft humerus through anterolateral approach is safe, effective and avoids release of deltoid tendon insertion and also avoids radial nerve dissection and its injury.

Functional outcome of middle third humeral shaft fractures treated with anteromedial plate osteosynthesis through an anterolateral approach

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The main aim of treatment of the humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. Plate osteosynthesis remains the standard of surgical treatment displaced middle third humeral fractures. The most commonly used approaches for treating these fractures are posterior and anterolateral, but these approaches can have iatrogenic radial nerve injury. Our aim is to study the incidence of radial nerve palsy and functional outcome of anterolateral approach with anteromedial plating.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 26 patients in the age group of 21 to 62 years were included in this prospective study, who were treated by anteromedial plating through anterolateral approach for humerus shaft. Functional assessment was done using Rodriguez-Merchan criteria.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 26 patients with shaft humerus fracture were included in the study with 19 (73%) patients were less than 40 years age. Most common type of fracture pattern is A3 type and the mean duration of surgical time was 60±10 min for anteromedial plating. The time taken for the fracture union was less than 4 months in the most patients (88%). There was no evidence of iatrogenic radial nerve injury. Functional assessment done using Rodriguez-Merchan criteria showed 84.6% of the patients had good to excellent functional outcome.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; For treatment of displaced middle third humeral fractures open reduction with anteromedial plating through anterolateral approach is surgically safer and gives better functional outcome.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Outcome of radial nerve injury associated with fracture humeral shaft fractures treated with open reduction and internal fixation

Radial nerve palsy with humeral shaft fracture is common injury which can result in significant motor and sensory impairment of the arm and the wrist, leading to a serious handicap. We attempted to find out the incidence of radial nerve palsy associated with humeral shaft fractures and its outcome after open reduction and internal fixation in 25 patients of complete primary radial nerve palsy in a total of 160 adult patients of with diaphyseal fracture of humerus with mean age of 33.2 years. The union was achieved in all 25 patients, at mean on 16.2 weeks with mean DASH score of 21.2 with 22 (88%) patient had excellent to good outcome and only one patients had poor outcome and fair results in 2 patients. In all the patients except in one patient, the nerve recovered fully within 9 months with mean recovery time of 14.1 weeks (range 4 weeks to 7 months). To conclude, Radial nerve palsy is common with middle third oblique fractures of humeral shaft which is commonly neuropraxia with anatomical continuity which recovers completely in mean duration of four months without the need of any surgical repair.

INCIDENCE AND PROGNOSIS OF RADIAL NERVE LESION ASSOCIATED WITH HUMERAL SHAFT FRACTURE

Background &#x0D; Humerus is the long bone of the arm, radial nerve which is branch from the posterior cord of the brachial plexus commonly injured by fracture shaft of humerus because of close relation to the bone during it’s course in the arm, and the average incidence of radial nerve palsy with fracture of humerus in the literature is 12%.&#x0D; Objective&#x0D; To study incidence, types and nature of radial nerve injury associated with humeral shaft fracture.&#x0D; Subjects and Methods&#x0D; This is prospective study conducted at the Sulaimani Teaching Hospital and Causality Hospital during the period of June 2009 – June 2010. The study included sixty-eight patients with fracture shaft of hummers (21 females, 47 males), with an age ranging from 6 to 75 years (mean ±SE = 40± 0.67 years). Among the 68 patients 14 of them presented with neurological deficit of radial nerve dysfunction with an age ranging from 6 to 44 years (mean ±SE = 25 ± 0.67 years) (6 female and 8 male). The entire subjects met certain inclusion and exclusion criteria. Nerve Conduction Study and needle electromyography examinations were performed for those patients with radial nerve Dysfunction. The following biochemical parameter were measured complete blood count, serum calcium, serum alkaline phosphatase also X ray examination were performed in more than one view (anterior-posterior and lateral view).&#x0D; Results&#x0D; Among 68 patients with fractured humeral shaft 14 of them presented with feature of radial nerve palsy, nerve conduction study and electromyographic result showed that 10 patients (72%) have only focal demyelinating lesion (neuropraxia), (21%) 3 patients with severe radial nerve injury (neurotmesis) and 1 patient (7%) with partial radial nerve injury (axonotmesis) with the over all prevalence of about 20.6%. Among those patients with radial nerve palsy 3 of them was presented with compound fracture and associated severe radial nerve injury (neurotmesis), the remaining 11 patients presented with closed fracture..&#x0D; Conclusions&#x0D; The incidence of radial nerve palsy with fractureed shaft humerus was 20.6%, transection of radial nerve is associated with open fractures of the humerus, nerve palsies that are part of closed fracture nearly always recovered.

Incidence and predictors of radial nerve palsy with the anterolateral brachialis splitting approach to the humeral shaft

PurposeFractures of the humeral shaft are common and account for 3%–5% of all orthopedic injuries. This study aims to estimate the incidence of radial nerve palsy and its outcome when the anterior approach is employed and to analyze the predictive factors. MethodsThe study was performed in the department of orthopaedics unit of a tertiary care trauma referral center. Patients who underwent surgery for acute fractures and nonunions of humerus shaft through an anterior approach from January 2007 to December 2012 were included. We retrospectively analyzed medical records, including radiographs and discharge summaries, demographic data, surgical procedures prior to our index surgery, AO fracture type and level of fracture or nonunion, experience of the operating surgeon, time of the day when surgery was performed, and radial nerve palsy with its recovery condition. The level of humerus shaft fracture or nonunion was divided into upper third, middle third and lower third. Irrespective of prior surgeries done elsewhere, the first surgery done in our institute through an anterior approach was considered as the index surgery and subsequent surgical exposures were considered as secondary procedures. ResultsOf 85 patients included, 19 had preoperative radial nerve palsy. Eleven (16%) patients developed radial nerve palsy after our index procedure. Surgeons who have two or less than two years of surgical experience were 9.2 times more likely to induce radial nerve palsy (p = 0.002). Patients who had surgery between 8 p.m. and 8 a.m. were about 8 times more likely to have palsy (p = 0.004). The rest risk factor is AO type A fractures, whose incidence of radial nerve palsy was 1.3 times as compared with type B fractures (p = 0.338). For all the 11 patients, one was lost to follow-up and the others recovered within 6 months. ConclusionContrary to our expectations, secondary procedures and prior multiple surgeries with failed implants and poor soft tissue were not predictive factors of postoperative deficit. From our study, we also conclude that radial nerve recovery can be reasonably expected in all patients with a postoperative palsy following the anterolateral approach.

Treatment of Middle Third Humeral Shaft Fractures with Anteromedial Plate Osteosynthesis through an Anterolateral Approach.

Background: Treatment of humeral shaft fractures has been a subject of debate for many decades. Even though a large majority of humeral shaft fractures can be treated by non operative methods, few conditions like open fractures, polytrauma, ipsilateral humeral shaft and forearm fractures require surgical intervention. The goal of treatment of humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. The objective was to assess the incidence of radial nerve palsy, non-union and mean time required for in anteromedial plate osteosynthesis with anterolateral approach and also to measure the functional outcome of this procedure.Method: A prospective study was conducted in the Department of Orthopaedics, PESIMSR, Kuppam, Andhra Pradesh, from August 2012 to August 2015 with a total of 54 patients who were operated with anteromedial plate osteosynthesis were included in the study. Rodriguez- Merchan criteria was used to grade the functional outcome.Results: Of the 54 patients, 28 (58.85%) were in the age group of 30-40 years. The most common fracture pattern identified was A3 type (48.14%).The mean (± SD) duration of surgery for anteromedial humeral plating was 53 ± 5.00 minutes. The time taken for the fracture to unite was less than 16 weeks in the majority or 50 patients (92.59%). Four (7.40%) patients had delayed union. There was no incidence of iatrogenic radial nerve palsy. Rodriguez – Merchan criteria showed that 37(68.51%) of the patients had good and 12 (22.22%) had excellent functional outcome.

Outcome of Nonoperative vs Operative Treatment of Humeral Shaft Fractures: A Retrospective Study of 213 Patients

Standard treatment for most humeral shaft fractures is nonoperative functional bracing; however, certain clinical scenarios necessitate operative intervention. There have been few studies in the literature comparing nonoperative and operative fixation of humeral shaft fractures. Two-hundred thirteen adult patients with a humeral shaft fracture who satisfied inclusion criteria were treated at 2 level 1 trauma centers with either a functional brace (nonoperative treatment group) or compression plating (operative treatment group). Main outcome measures were evaluated retrospectively and included time to union, nonunion, malunion, infection, incidence of radial nerve palsy, and elbow range of motion (ROM). The occurrence of nonunion (20.6% vs 8.7%; P=.0128) and malunion (12.7% vs 1.3%; P=.0011) was statistically significant and more common in the nonoperative group. There was no significant difference in infection rate between nonoperative and operative treatment (3.2% vs 4.7%; P=1.0000). Radial nerve palsy presented after fracture treatment in 9.5% of patients in the nonoperative group and in 2.7% of patients managed operatively (P=.0678). No difference in time to union or ultimate ROM was found between the 2 groups. Closed treatment of humerus fractures had a significantly higher rate of nonunion and malunion while operative intervention demonstrated no significant differences in time to union, infection, or iatrogenic radial nerve palsy. Nonoperative management has historically been the treatment of choice for many humeral shaft fractures, however, in certain clinical scenarios these fractures may be well served by compression plating.

Outcome of Nonoperative vs Operative Treatment of Humeral Shaft Fractures: A Retrospective Study of 213 Patients

Standard treatment for most humeral shaft fractures is nonoperative functional bracing; however, certain clinical scenarios necessitate operative intervention. There have been few studies in the literature comparing nonoperative and operative fixation of humeral shaft fractures. Two-hundred thirteen adult patients with a humeral shaft fracture who satisfied inclusion criteria were treated at 2 level 1 trauma centers with either a functional brace (nonoperative treatment group) or compression plating (operative treatment group). Main outcome measures were evaluated retrospectively and included time to union, nonunion, malunion, infection, incidence of radial nerve palsy, and elbow range of motion (ROM). The occurrence of nonunion (20.6% vs 8.7%; P=.0128) and malunion (12.7% vs 1.3%; P=.0011) was statistically significant and more common in the nonoperative group. There was no significant difference in infection rate between nonoperative and operative treatment (3.2% vs 4.7%; P=1.0000). Radial nerve palsy presented after fracture treatment in 9.5% of patients in the nonoperative group and in 2.7% of patients managed operatively (P=.0678). No difference in time to union or ultimate ROM was found between the 2 groups. Closed treatment of humerus fractures had a significantly higher rate of nonunion and malunion while operative intervention demonstrated no significant differences in time to union, infection, or iatrogenic radial nerve palsy. Nonoperative management has historically been the treatment of choice for many humeral shaft fractures, however, in certain clinical scenarios these fractures may be well served by compression plating.