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Radial Nerve Injury at the Humerus

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1. Time from injury to surgical fixation of diaphyseal humerus fractures is not associated with an increased risk of iatrogenic radial nerve palsy. (PubMed)

Time from injury to surgical fixation of diaphyseal humerus fractures is not associated with an increased risk of iatrogenic radial nerve palsy. To determine whether time from injury to fixation of diaphyseal humeral fractures and nonunions is associated with the risk of iatrogenic radial nerve palsy.Retrospective review.Two Level 1 trauma centers.Between 2001 and 2015, 325 patients who had documented intact radial nerve function preoperatively were treated with fixation of a humerus fracture (...) or humerus nonunion.Open reduction and internal fixation.Development of an iatrogenic radial nerve injury. Those with an injury were followed to either resolution of the nerve palsy or definitive treatment.The risk of iatrogenic radial nerve palsy was 7.7% (25/325). Time to surgery was not significantly associated with iatrogenic radial nerve palsy. In a multiple variable analysis, when comparing patients treated within 4 weeks to those treated 4-8 weeks (P = 0.41), 8-12 weeks (P = 0.94), and over 12

2017 Journal of Orthopaedic Trauma

2. Radial Nerve Injury at the Humerus

Radial Nerve Injury at the Humerus Radial Nerve Injury at the Humerus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Radial Nerve (...) Injury at the Humerus Radial Nerve Injury at the Humerus Aka: Radial Nerve Injury at the Humerus , Saturday Night Palsy , Honeymooner's Wrist Drop , Sleep Paralysis , Crutch Palsy , Wrist Drop , Radial Nerve Compression , Radial Neuropathy , Radial Nerve Palsy From Related Chapters II. Pathophysiology tracks follows the spiral groove down the medial III. Causes Mid-shaft humerus Direct injury to the as it lies in spiral groove Does not typically affect elbow extension (triceps) Axilla compression

2019 FP Notebook

3. Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord. (PubMed)

Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord. OBJECTIVE Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years (...) . CONCLUSIONS The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good results. Based on these criteria, overall good results were obtained in only 5 of the 13 patients. In proximal radial nerve lesions, the authors now advocate combining nerve grafts with nerve or tendon transfers to reconstruct wrist, thumb, and finger extension.

2016 Journal of Neurosurgery

4. Outcomes of Radial Nerve Grafting In Children After Distal Humerus Fracture. (PubMed)

Outcomes of Radial Nerve Grafting In Children After Distal Humerus Fracture. To report the results of radial nerve grafting in 7 children who sustained a radial nerve injury following a distal humeral fracture.Seven children, mean age 6 years (range, 4-11 years), underwent nerve grafting for radial nerve injuries following distal humeral fractures. The mean interval between injury and surgery was 6.7 months (range, 6-9 months). In all cases, 3 sural nerve graft cables were used, of mean length (...) as M4, obtaining full metacarpophalangeal finger and thumb extension, with the wrist in neutral in 3 patients and fully extended in 4. During the thumbs-up test, 4 patients achieved complete extension of all thumb joints, and 3 exhibited metacarpophalangeal extension lag, averaging 30°.Nerve grafting of radial nerve injuries at the level of the distal humerus in children can yield excellent outcomes.Therapeutic V.Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc

2018 Journal of Hand Surgery - American

5. Minimally invasive lateral plate placement for metadiaphyseal fractures of the humerus and its implications for the distal deltoid insertion- it is not only about the radial nerve. A cadaveric study. (PubMed)

Minimally invasive lateral plate placement for metadiaphyseal fractures of the humerus and its implications for the distal deltoid insertion- it is not only about the radial nerve. A cadaveric study. Minimally invasive lateral placement of plates on the humerus may be associated with a risk of injury to the radial nerve. Whereas this potential complication has been investigated in several studies, there is no data regarding potential injuries to the distal insertion of the deltoid muscle when (...) and their insertions at the humerus. The position of the plate and its relation to the intramuscular tendons of the deltoid was explored. Furthermore, potential injuries to the axillary and radial nerve were investigated. Damage to the brachialis muscle its interference with plate positioning were explored.The distal deltoid insertion was affected in all eight examined arms. The two most anterior and two most posterior segments were intact in all. In two arms, the third intramuscular tendon was perforated

2017 Injury

6. Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord. (PubMed)

Results of nerve grafting in radial nerve injuries occurring proximal to the humerus, including those within the posterior cord. OBJECT Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years (...) . CONCLUSIONS The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good results. Based on these criteria, overall good results were obtained in only 5 of the 13 patients. In proximal radial nerve lesions, the authors now advocate combining nerve grafts with nerve or tendon transfers to reconstruct wrist, thumb, and finger extension.

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2015 Journal of Neurosurgery

7. Study of Radial Nerve Injury Caused By Gunshot Wounds and Explosive Injuries among Iraqi Soldiers (PubMed)

, of which 127 patients were included with an open fracture and 191 patients with closed lesions. All 127 patients with a transected radial nerve had an open humerus fracture and were part of a complex upper-extremity injury. 113 of 127 subjects had primary repair of the radial nerve and recovered well. 14 of 127 subjects were not recovered. 3 of them had iatrogenic radial nerve injury due to the internal fixation device. Furthermore, all 191 patients with closed injuries recovered well. The average time (...) the condition of the injuries and presents the treatment conditions with many challenges. However, the success rate in post-surgical recovery of humerus fracture and injured radial nerve can be remarkably higher in young people as compared to other age groups.

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2018 Open access Macedonian journal of medical sciences

8. Anatomic variant of the inferior lateral cutaneous branch of the radial nerve during the posterior approach to the humerus: a case report (PubMed)

Anatomic variant of the inferior lateral cutaneous branch of the radial nerve during the posterior approach to the humerus: a case report Iatrogenic injury during the posterior approach to the humerus during operative fixation is not an uncommon occurrence. A comprehensive understanding of the normal anatomy and its variants is of paramount importance in order to avoid such injury. Typically, the inferior lateral cutaneous branch of the radial nerve originates towards the distal end (...) of the humerus at the inferior portion of the spiral groove. Here, we report an important variant of this nerve, which originated significantly more proximal than expected, further emphasizing the importance of identification, dissection and protection of the radial nerve and its major branches.

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2015 Patient safety in surgery

9. A case report of periprosthetic fracture left proximal humerus with radial nerve palsy following pectoralis major repair (PubMed)

A case report of periprosthetic fracture left proximal humerus with radial nerve palsy following pectoralis major repair Primary repair of pectoralis major tendon with bony tunnels and anchor sutures in the proximal humerus creates a potential weakness and stress riser leading to increased risk of periprosthetic fracture and nerve damage at the site of weakness with subsequent injury, if not allowed to heal satisfactorily with adequate period of rest.

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2015 Clinical Case Reports

10. Sensory reanimation of the hand by transfer of the superficial branch of the radial nerve to the median and ulnar nerve (PubMed)

Sensory reanimation of the hand by transfer of the superficial branch of the radial nerve to the median and ulnar nerve It remains a surgical challenge to treat high-grade nerve injuries of the upper extremity. Extra-anatomic reconstructions through the transfer of peripheral nerves have gained clinical importance over the past decades. This contribution outlines the anatomic and histomorphometric basis for the transfer of the superficial branch of the radial nerve (SBRN) to the median nerve (...) (MN) and the superficial branch of the ulnar nerve (SBUN).The SBRN, MN, and SBUN were identified in 15 specimens and the nerve transfer performed. A favorable site for coaptation was chosen and its location described using relevant anatomical landmarks. Histomorphometric characteristics of donor and target were compared to evaluate the chances of a clinical success.A suitable location for dissecting the SBRN was identified prior to its first bifurcation. Coaptations were possible near the pronator

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2016 Brain and behavior

11. CRACKCast E052 – Orthopedics – Humerus and Elbow

and blood vessels: Brachial artery travels in the anterior compartment with the median nerve alongside it The anatomy at the AC fossa: The radial nerve: Spirals around the humerus posteriorly, and re-enters the anterior compartment laterally (LE) to power the wrist and finger extensors **the radial nerve is VERY susceptible to injury with any midshaft humerus fracture** Because it is fixed in the intermuscular septum, the nerve can become trapped when reduction is attempted. The ulnar nerve: Runs (...) parallel to the median nerve until half-way down the humerus, and then it moves medially It passes BEHIND the medial epicondyle which puts it at risk of injury. Elbow Bursae: Olecranon bursa (elbow skin gliding) Radiohumeral bursa (supination/pronation) Bicep tendon cushioning bursa – protects the radius during elbow flexion Clinical features: History: standard stuff Physical: Compare bilaterally In kids: Note the position it is held in: Extension type supra-condylar #’s are held at the side with an S

2016 CandiEM

12. Incidence and predictors of radial nerve palsy with the anterolateral brachialis splitting approach to the humeral shaft (PubMed)

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

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2016 Chinese Journal of Traumatology

13. Radial Nerve Injuries. (PubMed)

Radial Nerve Injuries. Radial nerve injuries continue to challenge hand surgeons. The course of the nerve and its intimate relationship to the humerus place it at high risk for injury with humerus fractures. We present a review of radial nerve injuries with emphasis on their etiology, workup, diagnosis, management, and outcomes. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

2015 Journal of Hand Surgery - American

14. Approach to radial nerve palsy caused by humerus shaft fracture: is primary exploration necessary? (PubMed)

Approach to radial nerve palsy caused by humerus shaft fracture: is primary exploration necessary? While recommendations for early exploration and nerve repair in cases of open fractures of the humeral shaft associated with radial nerve palsy are clear, the therapeutic algorithm for the management of closed humeral shaft fractures complicated by radial nerve palsy is still uncertain. The purpose of this study was to determine whether patients with complete sensory and motor radial nerve palsy (...) of them (10%) total nerve transection was found. In the rest 10 patients underwent surgical exploration the radial nerve was found to be macroscopically intact. All intact nerves were fully recovered after a mean time of 21.6 weeks (range: 20-24 weeks) post-injury. In 13 patients (52%) in whom surgical exploration was not performed the mean time to full nerve recovery was 12 weeks (range: 7-14 weeks) post-injury.We proposed immediate exploration of the radial nerve in case of open fractures

2013 Injury

15. Management of AO type 12C humerus proximal metadiaphyseal fractures with minimally invasive plate osteosynthesis in geriatric patients (PubMed)

scores from 6 months to 1 year was statistically significant (p<0.0001). The decrease in the Q-DASH scores between 6 months and 1 year was determined to be statistically significant. In the 2 patients with radial nerve palsy, the functions were seen to completely recover during follow-up. No axillary nerve palsy was seen in any patient.Metadiaphyseal humerus fractures with proximal extension in the elderly can be successfully treated with the lateral MIPO technique. When applied correctly (...) for a humerus diaphyseal fracture with proximal extension during the period January 2011 to December 2016. None of the patients had additional injuries and all completed regular follow-up. According to the Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation classification system, the fractures were evaluated as 12C1 in 17 cases and 12C3 in 4 cases. All patients were evaluated radiologically and functionally at 6 months and 1 year. In the follow-up evaluations

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2018 Clinical interventions in aging

16. Lateral Subcutaneous Locking Compression Plate and Small Incision Reduction for Distal‐third Diaphyseal Humerus Fractures (PubMed)

Lateral Subcutaneous Locking Compression Plate and Small Incision Reduction for Distal‐third Diaphyseal Humerus Fractures Iatrogenic radial nerve injury is a great challenge for orthopaedic surgeons who deal with distal-third diaphyseal humerus fractures. Conventional open reduction and internal fixation (ORIF) remains the gold standard, but complications such as nonunion and iatrogenic radial nerve injury still occur. We fixed the fractures with a lateral locking compression plate (LCP (...) ) subcutaneously after small incision reduction to protect the radial nerve. This study reports the clinical and radiographic outcomes of our modified method.Thirty-eight patients with distal-third diaphyseal humerus fractures were treated with lateral subcutaneous LCP and small incision reduction at our department between September 2013 and August 2016. There were 33 males and 5 females, with an average age of 30.3 years (range, 17 to 49 years). All the cases were types A or B (AO/OTA classification, type

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2018 Orthopaedic surgery

17. Radial Nerve Entrapment: Diagnosis and Treatment

. Returning to Work following Surgery VII. ELECTRODIAGNOSTIC WORKSHEET References *This guideline does not apply to severe or acute traumatic injury to the upper extremities. 2 I. Review Criteria *Work-Related Radial Nerve Entrapment: radial tunnel syndrome (RTS) or posterior interosseous nerve syndrome (PINS) Review Criteria for the Diagnosis and Treatment of Work-Related Radial Nerve Entrapment (RNE*) CLINICAL FINDINGS CONSERVATIVE TREATMENT SURGICAL TREATMENT SUBJECTIVE (Symptoms) OBJECTIVE (Signs (...) : radial tunnel syndrome (RTS) or posterior interosseous nerve syndrome (PINS) 1,2 . Although RNE may occur from compression at any point along the course of the radial nerve due to acute trauma (e.g. humerus fracture, Saturday night palsy), space- occupying lesion (e.g. lipoma, ganglion), local edema or inflammation, this guideline focuses on RTS and PINS, which are more typical for RNE arising from repetitive work activities. RTS and PINS have been described to occur at one of five potential sites

2010 Washington State Department of Labor and Industries

18. Functional outcomes of Gartland III supracondylar humerus fractures with early neurovascular complications in children: A retrospective observational study. (PubMed)

involving both vascular compromise and neural injury). There were significant differences between the 2 groups in age (P  =  .048), weight (P  =  .009), and direction of displacement (P  =  .004). Vascular compromise and median nerve injury were most common in fractures with posterolateral displacement, and radial nerve injuries were common in fractures with posteromedial displacement. The mean global function score in the PODCI was 91.4 points, and the mean Quick DASH score was 11.7 points (...) Functional outcomes of Gartland III supracondylar humerus fractures with early neurovascular complications in children: A retrospective observational study. This was a retrospective observational study. The aim of this study was to evaluate functional outcomes in children treated for Gartland III supracondylar humerus (SCH) fracture with neurovascular (NV) injuries using validated outcome measures. A secondary goal was to determine whether clinical parameters such as age at injury, sex, weight

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2017 Medicine

19. Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials. (PubMed)

) or MIPO fixation (OR, 0.08; 95% CI, 0.00-0.69). Iatrogenic radial nerve injury occurred more commonly in the ORPF group than in the MIPO group (OR, 11.09; 95% CI, 1.80-124.20). There were no significant differences among the three procedures in nonunion, delayed union, and infection.Compared with IMN and ORPF, MIPO technique is the preferred treatment method for humeral shaft fractures. (...) Surgical interventions to treat humerus shaft fractures: A network meta-analysis of randomized controlled trials. There are three main surgical techniques to treat humeral shaft fractures: open reduction and plate fixation (ORPF), intramedullary nail (IMN) fixation, and minimally invasive percutaneous osteosynthesis (MIPO). We performed a network meta-analysis to compare three surgical procedures, including ORPF, IMN fixation, and MIPO, to provide the optimum treatment for humerus shaft

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2017 PloS one

20. Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies (PubMed)

Early Vessels Exploration of Pink Pulseless Hand in Gartland III Supracondylar Fracture Humerus in Children: Facts and Controversies The management of pink pulseless limbs in supracondylar fractures has remained controversial, especially with regards to the indication for exploration in a clinically well-perfused hand. We reviewed a series of seven patients who underwent surgical exploration of the brachial artery following supracondylar fracture. All patients had a non-palpable radial artery (...) , which was confirmed by Doppler ultrasound. CT angiography revealed complete blockage of the artery with good collateral and distal run-off. Two patients were more complicated with peripheral nerve injuries, one median nerve and one ulnar nerve. Only one patient had persistent arterial constriction which required reverse saphenous graft. The brachial arteries were found to be compressed by fracture fragments, but were in continuity. The vessels were patent after the release of obstruction

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2017 Malaysian orthopaedic journal

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