Primary Exploration of Radial Nerve is Not Required for Radial Nerve Palsy while Treating Humerus Shaft Fractures with Unreamed Humerus Nails (UHN)

G Grass, K Kabir, J Ohse, C Rangger, L Besch, G Mathiak, G Grass, K Kabir, J Ohse, C Rangger, L Besch, G Mathiak

Abstract

Background: Today, humerus nails have become the surgical method of choice in the treatment of humerus shaft fractures. Whether or not the radial nerve should be intraoperatively examined by default in case of primary paresis is currently under discussion.

Patients and methods: Clinical findings from 38 patients with humeral shaft fractures surgically treated with unreamed humerus nail (UHN) at the Department of Accident Surgery, University Clinics Bonn, Germany, between 2000 and 2003 were retrospectively assessed. Constant Score was applied for evaluation of functional results.

Results: In 40% of patients, primary radial nerve paresis was present. This was especially common after high energy trauma (e.g. traffic accident) and significantly increased in fractures of the middle third. In 93% of cases, spontaneous remission of motor and sensory loss was observed. No iatrogenic radial nerve impairment occurred.

Conclusion: Due to the high rates of spontaneous remissions of radial nerve palsy after treatment with UHN in humerus shaft fractures, primar exploration of the radial nerve does not appear to be necessary.

Keywords: Humerus shaft fracture; constant score.; palsy; radial nerve; unreamed humerus nail (UHN).

References

    1. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. 2002;87:1647–52.
    1. Böhler L. Against the operative treatment of fresh humeral shaft fractures. Langenbecks Archives Surgery. 1964;308:465–75.
    1. Nast-Kolb D, Knoefel WT, Schweiberer L. The treatment of humeral shaft fractures. Results of a prospective AO multicenter study. Unfallchirurg. 1991;94:447–54.
    1. Seidel H. Humeral locking nail: a preliminary report. Orthopedics. 1989;12:219–26.
    1. Tscherne H, Oestern HJ. Technique and results of rigid-plate fixation in forearm fractures. Unfallheilkd. 1982;85:111–6.
    1. Gustilo RB, Mendoza RM, Williams DN. Problems with the management of type 3 (severe) open fractures: a new classification of type 3 open fractures. J Trauma. 1984;24:742–6.
    1. Constant CR, Murley AHG. A Clinical Method of the Functional Assessment of the Shoulder. Clin Orthop. 1987;214:160–4.
    1. Blum J, Rommens PM, Janzig H, Langendorff HS. Retrograde nailing of humerus shaft fractures with the unreamed humerus nail. An international multicenter study. Unfallchirurg. 1998;101:342–52.
    1. Brehme K, Wawro W, Otto W. Unreamed Humerus nail (UHN): spectrum and results. Trauma Berufskh. 2000;2:277–83.
    1. Siebert CH, Heinz BC, Höfler H-R, Hansis M. Plate osteosynthesis management of humerus shaft fractures. Unfallchirurg. 1996;99:106–11.
    1. Tytherleigh-Strong G, Walls N, McQueen MM. The epidemiology of humeral shaft fractures. J Bone Joint Surg. 1998;80:249–53.
    1. Loitz D, Könnecker H, Illgner A, Reilmann H. Retrograde intramedullary nailing of humeral fractures with new implants. Analysis of 120 consecutive cases. Unfallchirurg. 1998;101:543–50.
    1. Schratz W, Wörsdörfer O, Klöckner C, Götze C. Treatment of humerus shaft fractures with different nail-systems (Seidel- nail, Marchetti-Vicenzi-nail, Prevot-Pins) Unfallchirurg. 1998;101:12–7.
    1. Rommens PM, Verbruggen J, Broos PL. Retrograde locked nailing of humeral shaft fractures- a review of 39 patients. J Bone Joint Surg. 1995;77:84– 9.
    1. Verheyden P, Streidt A, Lill H, Weise K, Josten C. Unreamed Humerus nail- indication, technique and results. Akt Traumatol. 1998;28:251–7.
    1. Rommens PM, Blum J. Retrograde Nailing of Fresh and Pathologic Humeral Shaft Fractures With a New Unreamed Humeral Nail (UHN) Techniques Orthopaedics. 1998;13:51–60.
    1. Klestil T, Rangger C, Gföller P, Rieger M. Conservative treatment of humerus shaft fractures. Trauma Berufskrankh. 2000;2:467–9.
    1. Marty B, Käch K, Friedl HP, Trentz O. Nailing of humerus shaft fractures. Unfallchirurg. 1994;97:424–9.
    1. Wawro W, Brehme K, Otto W. Radial palsy in humerus shaft fractures- indication for revision? Trauma Berufskh. 2000;2:284–7.
    1. Alnot J, Osman N, Masmejean E. Wodecki P Lesions of radial nerve in fractures of the humeral diaphysis. Apropos of 62 cases. Rev Chir Orthop Appar Mot. 2000;86:143–50.
    1. Samardzic M, Grujicic D, Milinkovic ZB. Radial nerve lesions associated with fractures of the humeral shaft. Injury. 1990;21:220–22.
    1. Sturzenegger M, Rutz M. Radial nerve paralysis--causes, site and diagnosis. Analysis of 103 cases. Nervenarzt. 1991;62:722–9.
    1. Rommens PM, Vansteenkiste F, Stappaerts KH, Broos PLO. Indication and results of operative traeted humerus shaft fractures. Unfallchirurg. 1998;92:556–70.
    1. Nast-Kolb D, Schweiberer L. Change in the treatment of humerus shaft fractures. Orthopädie. 1989;18:208–13.
    1. Brug E, Joist A, Meffert R. Postoperative radial paralysis. Fate or negligence, conservative wait or revision? Unfallchirurg. 2002;105:82–5.
    1. Brug E, Westphal T, Schäfers G. Differential treatment of diaphyseal humerus fractures. Unfallchirurg. 1994;97:633–0.
    1. Nast-Kolb D, Ruchholtz S, Schweiberer L. Indication and technique in non-operative treated humerus shaft fractures. Akt Traumatol. 1997;27:80–85.
    1. Bonnaire F, Götze B, Schlickewei W, Zenz M. Indication, technique and results of OSIF in humerus shaft fractures. Akt Traumatol. 2001;31:82–9.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera