Need for early exploration of radial nerve in humeral shaft fractures with radial nerve palsy
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TRAUMA SURGERY
Need for early exploration of radial nerve in humeral shaft fractures with radial nerve palsy Jin‑Hyung Im1 · Dong Kyu Moon2 · Ji‑Yong Gwark1 · Hyung Bin Park1,3 Received: 12 December 2019 / Accepted: 16 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Radial nerve palsy (RNP) associated with humeral shaft fracture (HSF) is the most common nerve complication in long bone fractures. There is still controversy over the need for immediate exploration of the radial nerve (RN) in HSF with RNP. The purpose of the current study was to determine which situations of HSF with RNP require early exploration of the RN. Materials and methods This is a retrospective study that included 55 patients who had visited the emergency department of the current authors’ hospital and had been diagnosed with HSF between March of 2005 and September of 2015. Of these 55 patients, 14 (25.4%) had been diagnosed with HSF with RNP. We reviewed the medical records of those 14 patients and their radiographs to evaluate each fracture’s type, location, pattern, energy of trauma, status of RN injury, and time until recovery from RNP. Result All the 14 RNP patients had suffered high-energy trauma. Three had fractures in the proximal third (21.4%), six in the middle third (42.9%), and five in the distal third (35.7%). The three patients (21.4%) with incomplete recovery of RNP all had proximal third fractures; two of these three patients had RN transection. Conclusion Early exploration of the radial nerve should be considered in patients with radial nerve palsy associated with proximal third humeral shaft fracture, regardless of the fracture patterns caused by the high-energy trauma. Keywords Radial nerve palsy · Humeral shaft fracture · Nerve exploration · High-energy trauma
Introduction The radial nerve (RN) is a structure that is made vulnerable by a humeral shaft fracture (HSF) because of the nerve’s anatomical course and its relationship to surrounding structures [1–5]. Radial nerve palsy (RNP) has been reported as an associated lesion of HSF, and its prevalence has been reported to range from 9.1 to 17% [6–8]. The optimal timing for exploration of the RN in patients with RNP associated with HSF remains controversial [8–10]. Because early * Hyung Bin Park [email protected] 1
Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, 11 Samjeongja‑ro Seongsan‑gu, Changwon 51472, Republic of Korea
2
Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea
3
Institute of Health Science and School of Medicine, Gyeongsang National University, Jinju, Republic of Korea
exploration is technically easier and safer than delayed exploration and reduces further nerve injury, several authors have recommended early exploration of RN during open reductions and internal fixations for HSF with RNP [1, 11, 12]. However, several studies have reported that more than 80% of the cases of RNP associated with HSF recove
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