Radial Nerve Research Articles (Page 1)

BackgroundAmyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease with peripheral nerve involvement, but current diagnostics are limited. Diffusion tensor imaging (DTI) may improve microstructural assessment and correlate with clinical markers. We investigated the diffusion properties of the brachial plexus in ALS and examined their relationships with electrophysiological parameters of upper limb nerves.Materials and methodsWe enrolled 25 ALS patients and 22 age- and sex-matched healthy controls. DTI of the brachial plexus was conducted to measure fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD). Differences in DTI parameters between the two groups were analyzed. Correlations between DTI parameters and ALS Functional Rating Scale-Revised (ALSFRS-R) scores, along with electrophysiological measurements, were assessed.ResultsIn ALS patients compared to controls, FA and AD values were significantly lower (p ≤ 0.002), while the RD value was significantly higher (p = 0.002). There were no statistically significant differences in MD (p = 0.540). Both FA and AD showed a positive correlation with ALSFRS-R score, ALSFRS-upper limb score, and compound muscle action potential amplitude of median, ulnar, and radial nerves (r ≥ 0.480; p ≤ 0.015). The RD values showed a negative correlation with ALSFRS-upper limb score and motor nerve conduction velocity of median, ulnar, and radial nerves (r ≤ -0.415; p ≤ 0.039).ConclusionFA, AD, and RD values of DTI showed the potential to identify microstructural changes in the brachial plexus nerve roots of ALS patients and may serve as potential indicators of nerve conduction function in the upper extremities.Relevance statementDTI may reveal microstructural changes in ALS brachial plexus, correlating with nerve dysfunction, offering novel biomarkers for evaluation of upper limb neurodegeneration.Key PointsLower Fractional anisotropy (FA) and axial diffusivity (AD), and higher radial diffusivity (RD) were shown in amyotrophic lateral sclerosis (ALS) brachial plexus.Diffusion tensor imaging (DTI) parameters correlated with clinical and electrophysiological parameters.FA, AD, and RD detected ALS nerve microstructural changes, indicating abnormal conduction function.Graphical

Background: Humeral shaft fractures (HSFs) represent 13–25% of humeral fractures and are frequently complicated by radial nerve palsy and nonunion. While conservative management was historically preferred, surgical fixation with intramedullary nailing (IMN) has gained increasing popularity. The aim of this study was to evaluate the effectiveness of IMN in the treatment of HSFs, focusing on postoperative complications and functional outcomes. Methods: A bicenter retrospective analysis was conducted on 202 patients who underwent antegrade IMN fixation for HSF between 2014 and 2019, with a minimum follow-up of four years. Demographic data, trauma characteristics, surgical details, and postoperative complications were recorded. Functional outcomes were assessed at one year using the Disabilities of the Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), Constant Shoulder Score (CSS), and Visual Analogue Scale (VAS). Statistical analysis included ANOVA, Student’s t-test, Spearman’s correlation, and multivariate regression. Results: The mean follow-up was 57.7 ± 19.6 months. At one year, mean OSS, DASH, CSS, and VAS scores were 39.0, 16.6, 73.5, and 0.9, respectively. Excellent or good Constant outcomes were recorded in 89.6% of patients. Sixteen complications (7.9%) occurred, including nerve injuries (4.0%) and pseudoarthrosis (1.5%). Patients operated within 48 h had significantly better functional scores compared to those treated later (p < 0.01). No differences were found according to fracture pattern, sex, diabetes, or osteoporosis. Age showed a weak correlation with functional outcomes. Conclusions: IMN is a safe and effective option for the treatment of HSFs, with high rates of functional recovery and a low incidence of complications. Early surgical intervention appears to improve outcomes, supporting its role as a valuable strategy in HSF management.

Radial nerve injury secondary to screw compression following internal fixation for a midshaft humeral fracture: A case report

Outcomes in restoration of shoulder abduction in upper trunk brachial plexus injuries: a randomized study comparing ipsilateral C7 fascicle and spinal accessory nerve as donor nerves.

Entrapment Neuropathies.

BackgroundThe brachial plexus shows frequent anatomical variations that can complicate diagnosis, surgical planning, and anesthetic procedures. Detailed knowledge of these variations is essential to prevent iatrogenic injury and improve clinical outcomes.Materials and MethodsEighteen donors (36 upper limbs) were dissected at Mercer School of Medicine, Columbus, Georgia, United States. The sample included 10 males and 8 females, aged 36–89 years (mean age: 67.67 years). Dissections followed Grant′s Dissector, 17th edition, with all variations in the infraclavicular brachial plexus and its branches in the axillary region and upper arm documented, photographed, and measured.ResultsVariations were found in 16 brachial plexuses (44.4%) from nine donors. In total, 32 variations were identified, involving the medial and posterior cords, median, musculocutaneous, ulnar, radial, axillary, lower subscapular, and thoracodorsal nerves. Bilateral variations were more common (77.8%) than unilateral ones (22.2%), often with two to three variants on one side. Several rare or previously undescribed findings were noted, including a median nerve with an accessory lateral root located between the main and aberrant axillary arteries, a rare communication between the medial cord and lateral root of the median nerve, a rare communication between the ulnar and median nerves in the upper arm, bifurcation of the musculocutaneous nerve, trifurcation of the radial nerve, trifurcation of the axillary nerve, posterior division of the axillary nerve passing through the triangular space, posterior division of the axillary nerve supplying both teres minor and teres major, bifurcated axillary nerve accompanied by an accessory subscapularis muscle, accessory thoracodorsal nerve arising from the axillary nerve, and quadfurcation of the posterior cord.ConclusionContrary to previous literature, axillary nerve variations were the most common. Bilateral deviations were frequent, often associated with arterial variations. Multiple rare and undescribed patterns identified in this study expand current knowledge of infraclavicular brachial plexus anatomy.

Background: Humeral shaft fractures (HDF) in adults account for 2% of all fractures. Surgical treatment can be either closed or open. Methods: This was a retrospective, descriptive and evaluative study conducted from January 2020 to December 31, 2023, at Centre Hospitalier National Matlaboul Fawzaini de TOUBA (CHNMFT) on 42 cases. The exclusion criteria were all patients under 15 years of age receiving orthopaedic treatment. Results: The average age of our patients was 40 years, with a male predominance. The most common circumstances were road traffic accidents (32 cases). According to the AO classification, type A fractures were the majority (32 cases). According to the surgical technique, pinning was the most common (22 cases). No complications were noted and all our patient’s achieved union within 12 to 24 weeks. At a mean follow-up of 13.5 months, according to the modified Stewart and Hundley classification, 61% of our patients were classified as Good versus 32% as Very Good. Conclusions: FDHs in adults are very common. The radial nerve remains the dread of every surgeon and surgical treatment yields the best results.

Objective:The objectives of this study are to (1) present a technique trick for intramedullary nailing of the humerus with the patient in lateral decubitus position and arm in an arthroscopic shoulder distractor to aid in utilizing the Neviaser portal to obtain access to a medialized start point and (2) present outcomes with this technique at a single institution.Design:Retrospective chart review.Setting:Academic Level 1 trauma center in South Carolina.Patients/Participants:Patients who underwent humeral nail fixation with this technique from March 2021 to March 2024 at a single academic level one trauma center were included.Intervention:Humeral intramedullary nail fixation.Main Outcome Measurements:Surgical duration, radiographic union, malunion rate, and rate of radial nerve palsy.Results:A total of 35 patients were included in the study. The median surgical duration was 60 minutes, with an estimated blood loss of 75 mL. Final intraoperative fluoroscopy images demonstrated no patients had greater than 10 degrees of varus/valgus or anterior/posterior angulation. All patients achieved radiographic union and none demonstrated malreduction at final follow-up. Two cases of postoperative radial nerve palsies occurred, yet neither was directly attributed to the nailing procedure.Conclusions:Intramedullary nailing of the humerus in lateral decubitus, combined with an arthroscopic distractor for a Neviaser portal start, is a reliable option for treating proximal and diaphyseal fractures. This technique achieved consistent union without radiographic malreduction. By minimizing the risk of rotator cuff violation, it can serve as a valuable addition to the orthopaedic traumatologist's operative armamentarium.

BackgroundPeripheral nerve injuries may accompany traumatic extremity injuries and are associated with significant morbidity. Diagnostic options are limited in young children since compliance might be restricted. High-resolution ultrasound (HRUS) is a promising technique to close the diagnostic gap, but clear recommendations are lacking. This study evaluates clinical outcomes after conservative versus surgical management, considering HRUS findings in pediatric patients with upper extremity peripheral nerve injuries.MethodsWe retrospectively analyzed our pediatric neurosurgery database from August 2008 to December 2022 including patients < 18 years with traumatic upper extremity nerve injury and excluding obstetrical brachial plexus injury. Systematic HRUS examinations were implemented from 2016 onwards. Clinical, intraoperative, sonographic and electrophysiological findings were assessed.ResultsA total of 73 nerve injuries in 67 patients (median age = 7.0 years) were analyzed. The most frequently affected nerves were the ulnar (49.3%), radial (21.9%), and median nerve (19.2%). At initial presentation, 47.9% underwent electrophysiology and 67.1% received HRUS. Surgery was performed in 49.3% at a median of 4 months posttrauma, whereas 50.7% were managed conservatively. Patients undergoing surgery initially had more severe sensory and motor deficits (χ2 = 3.98,p = 0.046), but final outcomes showed no significant difference in nerve function (median follow-up = 6.0 months). Binary logistic regression identified age (odds ratio [OR] = 1.3,p = 0.028), HRUS (OR = 10.6,p = 0.035), and injured nerve (OR = 3.1,p = 0.022) as independent outcome predictors.InterpretationGood functional recovery in pediatric patients with peripheral nerve injury was demonstrated. HRUS-guided treatment and age < 9 years were independent predictors of favorable outcome. These findings support HRUS as a valuable, noninvasive tool for guiding pediatric nerve injury management.

Supracondylar humerus fracture is a common elbow injury sustained in the pediatric population. Percutaneous pinning, whether all lateral or medial-lateral, is the mainstay of operative management for these injuries. There has been much debate on the safety of medial-sided pinning, with the literature indicating that medial-sided pinning can lead to iatrogenic ulnar nerve injury. Thus, the goal of our study is to describe the rates of nerve injuries (radial, median, and ulnar), loss of reduction, and range of motion between all lateral and medial-lateral treatment groups. Patients aged 1 to 18 years presenting at a pediatric hospital for a single, isolated supracondylar humerus fracture and treated with percutaneous pinning between 2018 and 2023 were reviewed. Patients with concurrent surgical treatment at the time of pinning, who presented with multiple injuries, had an open reduction, had an open fracture, or were lost to follow-up, were excluded. Age, sex, Gartland fracture classification, pinning method, nerve injury, range of motion, loss of reduction, and duration of follow-up were collected. Descriptive statistics were analyzed for variables of interest. A total of 406 pediatric patients were included. The average (SD) age at presentation was 5.7 (2.3) years, with 179 (44.1%) patients presenting with Type II fracture and 227 (55.9%) with Type III or IV. There were 131 (32.3%) patients treated with a medial-lateral pinning approach and 275 (67.7%) patients treated with an all-lateral pinning approach. Patients treated with a medial-lateral pinning experienced no new ulnar, radial, or median nerve injuries postoperatively. There was 1 (0.8%) patient with a loss of reduction, and 68.4% of patients with a medial pin had a full range of motion at their last follow-up. Patients treated with an all-lateral pinning approach experienced a new median nerve injury (n=1) and a new ulnar nerve injury (n=1) postoperatively. No patients with an all-lateral pinning approach had a loss of reduction, and 70.7% had a full range of motion at the last follow-up. This study demonstrated no occurrence of an ulnar nerve injury while utilizing the medial entry pins in the treatment of supracondylar fractures. Strict adherence to surgical principles pertaining to medial entry pins is crucial to avoid ulnar nerve injury and should be included in orthopaedic surgeon's armamentarium when treating unstable supracondylar fractures.

A 65-year-old woman presented with 3 months of progressive hand weakness, initially with distal-predominant symptoms. EMG was notable for diminished amplitudes in bilateral radial nerves without evidence of conduction block and with normal sensory nerve action potentials. Anti-acetylcholine receptor and antistriated muscle antibodies were positive, but subsequent EMG did not reveal abnormalities on repetitive nerve stimulation. Muscle biopsy was performed, revealing extensive inflammatory infiltrates with significant associated fibrosis. This case discusses the approach to localization within the motor pathway and the use of serologic studies, imaging, and electrodiagnostic testing to supplement history and examination.

Essential tremor (ET) is the most common form of arm tremor. Transcutaneous peripheral nerve stimulation (TPNS) can modulate the central tremor-generating network. To investigate whether an artificial intelligence (AI)-driven TPNS device is superior to a sham device in reducing ET. A randomized clinical trial was conducted from February 7 through August 9, 2024, in 12 outpatient neurology clinics in the United States and China. Participants were adults with upper-extremity tremor and a clinical diagnosis of ET, a tremor severity score of 2 or higher on 1 of the Essential Tremor Rating Assessment Scale (TETRAS) performance subscale tasks, a total performance subscale score of at least 7, and familiarity with operating a smartphone and connecting to Wi-Fi at home. They were randomized 2:1 to receive active TPNS or sham stimulation, stratified by use of ET medications and tremor severity. After the devices were fitted, the participants were instructed to use them during waking hours for 90 days. A wearable neuromodulation device that stimulates the radial, median, and ulnar nerves and uses AI to continuously adjust stimulation settings in real time. The primary outcome was change in daily activities as measured by the modified Activities of Daily Living (mADL) subscale of TETRAS at 90 days in the intention-to-treat population. Of 133 screened, 125 were randomized to receive TPNS (n = 83) or sham (n = 42) treatment. The mean (SD) age was 64.9 (13.1) years, 62 (49.6%) were female and 63 (50.4%) male, and the mean (SD) tremor duration was 11.4 (13.1) years. At 90 days, the mADL score was reduced by 6.9 points (95% CI, 5.4-8.4) in the TPNS group vs 2.7 points (95% CI, 1.3-4.0) in the sham group (P < .001). Skin irritation, the most common device-related adverse event, occurred in 28 of 83 participants (33.7%) in the TPNS group and 2 of 42 (4.8%) in the sham group. Nausea, arthralgia, worsening of existing arthritis in the thumb, muscular weakness, and involuntary muscle contractions each occurred in 1 participant, all in the TPNS group. The TPNS device improved activities related to upper limb tremor at 90 days and could be an effective noninvasive ET treatment. ClinicalTrials.gov Identifier: NCT06235190.

Objective: To explore the efficacy of precisely designed first dorsal metacarpal artery flap under the guidance of high-frequency color Doppler ultrasound in repairing small-sized skin and soft tissue defects in the thumb. Methods: This study was a retrospective observational study. From January 2021 to August 2023, 29 patients with small-sized skin and soft tissue defects in the thumb who met the inclusion criteria were admitted to the Department of Hand Surgery of the Second Hospital of Tangshan. There were 16 males and 13 females, with ages ranging from 22 to 65 years. The wound area after debridement ranged from 2.5 cm×1.5 cm to 3.0 cm×2.0 cm. Before flap transplantation, the body surface projections of the anastomotic branches between the first metacarpal radial dorsal artery and the radial proper digital artery of the affected finger measured by high-frequency color Doppler ultrasound examination were recorded. During surgery, the first dorsal metacarpal artery flap was harvested to repair the defects in the thumb, with the harvested flap area of 3.0 cm×2.0 cm to 3.5 cm×2.5 cm. The superficial branch of radial nerve carried by the flap was anastomosed with the proper digital nerve in the recipient area. The wound in the flap donor site was directly sutured. It was observed whether the body surface projections of the anastomotic branches between the first metacarpal radial dorsal artery and the radial proper digital artery of the affected finger measured by preoperative high-frequency color Doppler ultrasound examination were consistent with the intraoperative findings. After surgery, the wound healing and suture removal time in the donor and recipient sites, as well as the flap survival were observed. At the last follow-up (6-12 months postoperatively), the function of the affected finger was evaluated according to the trial criteria for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the excellent and good rate was calculated. The satisfaction scoring of flap efficacy was performed. Additionally, the two-point discrimination distance of flap was measured, and Semmes-Weinstein monofilament test was performed to evaluate flap sensory function. Results: The body surface projections of the anastomotic branches between the first metacarpal radial dorsal artery and the radial proper digital artery of the affected finger of 29 patients measured by preoperative high-frequency color Doppler ultrasound examination were all consistent with the intraoperative findings. After surgery, all wounds in the donor and recipient sites healed well, the suture removal time was 14-16 days postoperatively. The flaps survived completely in 26 patients, and the partial flap necrosis occurred in 3 patients. At the last follow-up, the functional score of the affected finger was 88±8, with the excellent and good rate of 96.6% (28/29). The satisfaction scoring of flap efficacy was 7.4±1.0, the two-point discrimination distance of flap was (6.9±0.7) mm, and the Semmes-Weinstein monofilament test result was (3.46±0.19) g. Conclusions: The application of precisely designed first dorsal metacarpal artery flap under the guidance of high-frequency color Doppler ultrasound in repairing small-sized skin and soft tissue defects in the thumb has the advantages of high flap survival rate, good functional recovery of the affected finger, and high satisfaction with flap efficacy.

Radial nerve injury after operative treatment of humeral shaft fracture usually improves, but a subgroup of patients does not recover. Understanding the probability of recovery over time is important in deciding on watchful waiting, nerve exploration, or tendon or nerve transfer. Bayesian analysis is helpful in estimating such probabilities. This type of analysis is predicated on estimating the probability that an event will occur and subsequently updating that estimate as new information becomes available-for instance, when nerve recovery does not occur over time. Using Bayesian methods applied to a previously studied cohort, we asked: (1) Over time, up to the end of 18 months, what is the probability of radial nerve motor recovery after surgical fixation of humerus fractures? (2) What variables are associated with the timing of radial nerve recovery? Between January 2002 and November 2014, we treated 375 patients with open reduction and internal fixation (ORIF) for a traumatic diaphyseal humeral fracture at six urban hospitals (two Level 1 trauma centers, two Level 2 trauma centers, and two community hospitals). From this previously studied cohort, we lost access to one hospital's data, leaving us with 295 records to screen for eligibility. We considered patients with an isolated preoperative or postoperative radial nerve palsy, defined as an inability to extend the wrist against gravity (Medical Research Council grade < 3), as potentially eligible. Based on that, 24% (72 of 295) were eligible; of those, 2.8% (2 of 72) were excluded because a nerve disruption was repaired during ORIF. Another 24% (17) had incomplete data sets, leaving 74% (53) for analysis here. Patients with incomplete data sets did not differ from analyzed patients with respect to demographics or injury characteristics. The median (IQR) age was 43 years (25 to 61), and 49% (26 of 53) of patients were male. Most palsies presented preoperatively (83% [44]). Motor recovery was defined as the ability to extend the wrist against gravity (Medical Research Council grade ≥ 3). We conceptualized the probability of radial nerve recovery over time as two conditional probabilities: (1) the probability that the nerve injury is recoverable (neuropraxia, or recoverable axonotmesis), and (2) the probability that it did not recover at a certain point in time. We used a Bayesian network analysis to model these two probabilities. We based our estimate of the probability of a recoverable nerve injury on the largest systematic review, in which 90% (438 of 488 [95% confidence interval (CI) 87% to 92%]) recovered. To reflect uncertainty, we repeated the analysis for the upper and lower limits of its CI. To estimate the probability that recovery did not happen yet at a certain point in time, we used the timing of recovery from the patients in our cohort. We used Cox proportional hazards analysis to examine associations between time to recovery and demographic and injury variables, including age, sex, fracture type and location, vascular injury, type of fixation, and timing of palsy (preoperative versus postoperative). If a nerve has not recovered by 7 months, the probability of nerve recovery by 18 months was still better than chance, at 56% (range 48% to 62%). If the nerve had not recovered by 1 year, then the probability of recovery was 17% (range 13% to 21%). No variables (such as age, fracture location, vascular injury, or fixation type) were associated with timing of radial nerve recovery. Providers can use our findings to counsel patients on the expected probability of nerve recovery, which might reduce anxiety while patients await recovery. These probabilities can aid in the decision whether and when nerve reconstruction, nerve transfers, or tendon transfers may be beneficial. Because the probability of recovery remains relatively high for at least 7 months after injury, early surgery is unlikely to be beneficial in patients with radial nerve motor injury after surgical fixation of humerus fractures. Future studies can provide more specific recovery probabilities by including findings on electrodiagnostic studies and patients treated nonoperatively. Level III, therapeutic study.

BackgroundRepairing large nerve defects remains challenging, and no definitive method has been established. We developed a nerve lengthening device for humans and achieved nerve defect repair through nerve lengthening in three cases. The purpose of this report is to describe the clinical course of three cases treated by nerve lengthening and to discuss its effectiveness in the treatment of nerve defects.MethodsThe target population included males and females aged 20–65 years with peripheral nerve injuries that cannot undergo primary suturing in the limbs were recruited. Three patients were included in this study. The nerve gaps were 13 mm, 15 mm and 100 mm, respectively. We developed a special nerve lengthening device. Starting from postoperative day 1, nerve lengthening was initiated on the proximal and distal ends at a rate of 0.5–1 mm daily (0.25 mm x 2–4 times) using the device. Monthly evaluations post-nerve suturing assessed nerve regeneration, pain, and adverse events. We observed postoperative courses for over 2 years.ResultsThere were two radial nerve injury cases and one median nerve injury case. Functional recovery was observed in cases of shorter nerve defects repaired through nerve lengthening. However, significant functional restoration was not attainable for cases of longer nerve defects or those with prolonged post-injury intervals. Furthermore, in chronic cases, it was confirmed that this method could be used to gradually lengthened and repair severed nerves. There were no reports of pain or lengthening-related troubles during nerve lengthening.ConclusionIt was found that good nerve regeneration can be achieved with short nerve defects. Compared to free nerve grafting, this new treatment is promising as it does not require the sacrifice of healthy nerves from the donor site or leave surgical scars. We demonstrated the potential of nerve lengthening as a new treatment option for nerve defects. This study is registered and published in the Japan Registry of Clinical Trials (Project No. jRCTs032180098, https://jrct.niph.go.jp/re/reports/detail/17847). Registration date: 28/01/2019.

Recovery of upper extremity function is considered the top priority in the tetraplegic population. Midcervical injury often results in paralysis of the hand and loss of elbow extension. Elbow extension is essential for extending one's workspace and facilitating mobility (ie, self-transfer, wheelchair propulsion). Tendon transfers have traditionally been used to restore elbow extension, but the axillary to radial nerve transfer (ARNT) has emerged as a promising alternative. Our objective was to review a case series of single-surgeon outcomes for recovery of elbow extension in the tetraplegic population after ARNT. An anterior, transaxillary approach for transfer of select branches of the axillary nerve to the long head triceps branch of the radial nerve was performed on adult traumatic spinal cord injury patients. Candidate screening consisted of physical examination and electrodiagnostic studies to determine absence of active elbow extension, presence of adequate axillary nerve function, Medical Research Council muscle power grade, American Spinal Injury Association Impairment Score motor level, and International Classification of Hand Surgery in Tetraplegia (ICHST) score. The participants and any identifiable individuals consented to publication of his/her image, and all patients consented to the procedure. Fifteen adult patients (ages 18-59 years) with a C5 or C6 motor level underwent ARNT on 25 limbs with a minimum 15-month follow-up (3 lost to follow up). The median time from injury to surgery was 10 months. Primary outcome was Medical Research Council strength grade 3 (2-4) with illustrative videos of each outcome. The ARNT provided at least M3 strength in 13 of 22 (59%) limbs. An additional 4 limbs achieved M2, providing functional benefit to the patient. Patients with a preoperative ICHST score of 3 or 4 all achieved antigravity strength overhead. No functional deficits due to donor nerve sacrifice was observed. Further investigation will be necessary to establish predictive factors for success of patients with ICHST scores 1 and 2. Overall, the ARNT is a good option for recovery of triceps function.

BackgroundAneurysmal bone cysts (ABCs) are benign, locally aggressive bone lesions that predominantly affect children and adolescents. The humerus is a common site, and treatment aims to eradicate the lesion while preserving growth potential and function. This study aimed to evaluate the clinical efficacy of curettage and bone grafting combined with electrocautery and burr drilling, supplemented with plate fixation, for treating pediatric humeral ABC.MethodsA retrospective analysis was conducted on 23 pediatric patients diagnosed with humeral ABC who underwent this surgical procedure. Inclusion criteria were age ≤18 years, a confirmed diagnosis via imaging and histopathology, and the absence of epiphyseal or joint surface involvement. The surgical techniques involved thorough curettage, electrocautery, burr drilling, bone grafting, and plate fixation. Postoperative follow-up included pain assessment using the Visual Analog Scale (VAS), functional evaluation using the Constant-Murley score, and radiographic imaging to assess bone healing and recurrence.ResultsThe average patient age was 8.6 years, and the mean follow-up period was 35.8 months. Postoperative pain scores (VAS) significantly decreased from a preoperative average of 5.6–1.1 at 1-year post-surgery (P < 0.05). Functional recovery, measured by the Constant-Murley score, improved from a preoperative average of 42–87 at 1-year post-surgery (P < 0.05). Radiographic evaluation confirmed complete lesion clearance and bone fusion in all patients, with no recurrence observed during the follow-up period. The overall complication rate was 17.39%, including one case of infection, two cases of wound dehiscence, and one case of transient radial nerve palsy, all of which were resolved with appropriate treatment.ConclusionThe combination of curettage, bone grafting, electrocautery, burr drilling, and plate fixation is a safe and effective treatment for pediatric humeral ABC. This approach ensures thorough lesion removal, promotes bone healing, and minimizes recurrence, making it a viable option for clinical application.

Comparison of sural and distal sural nerve responses: Diagnostic role of the amplitude ratio in diabetic polyneuropathy.

In this article, data of nerve and bone recovery were reported in a series of patients treated with open reduction and internal fixation (ORIF) with plate in humeral shaft fractures (HSF) associated with radial nerve palsy (RNP). The authors highlight the role of early surgical intervention for optimal nerve repair and patient's recovery, and to avoid subsequent and more complex surgery to patients. This is a retrospective study of 24 of 31 patients with HSF with RNP (10,1%) out of 308 patients with HSF, treated surgically between 2012 and 2023 in a level I Trauma Center. The mean age was 57 years. The mean follow-up time was 42 months (range 12-60). Twenty-seven were closed fractures and 4 were open. All patients were treated within 24 hours with ORIF with plate and exploration and decompression of radial nerve. The medical records of all patients and their X-ray were reviewed to evaluate fracture's type, location, energy of trauma, status of RN injury and, beyond the time of recovery from RNP, the time of bone healing and functionally recovery. We reviewed 24 patients, and 7 were lost to follow-up. All patients (100%) had good nerve palsy recovery in a mean time of 6.2 months. The mean X-ray bone consolidation occurred after 4 months. The mean time of Rom recovery was 4.46 months. None of our patients needed further surgery for the failure of the radial nerve recovery. In conclusion, our study, even of mall size, demonstrated that early surgical exploration of radial nerve during ORIF with plate of RHSF facilitates nerve repair and enhancing patient recovery. Furthermore, the low incidence of radial nerve palsy should not preclude surgical exploration, conversely, as many patients may have undiagnosed nerve injuries that can be addressed through timely intervention.Level of Evidence: Level IV, retrospective study.

While smooth, efficient mechanics and robust therapeutic soft tissue treatment may reduce injury risk in overhead throwing athletes, a simple holistic pre-event treatment approach utilizing nerve flossing techniques may be an effective avenue to combat Ulnar Collateral Ligament (UCL) injury among baseball pitchers. The purpose of this clinical suggestion is to consider the impact of nerve care for elite athletes in the prevention of UCL injury.Level of Evidence5