Enhanced nerve function recovery in radial nerve palsy patients with humerus shaft fracture: a randomized study of low-frequency pulse electrical stimulation combined with exercise therapy.

Objective: To evaluate the effect of low-frequency pulse electrical stimulation plus exercise therapy on nerve function recovery in patients with radial nerve palsy after humerus shaft fracture. Methods: A total of 110 patients with humerus shaft fracture and radial nerve injury admitted to our hospital from January 2017 to December 2021 were recruited. They were randomized to receive either conventional exercise therapy (control group) or conventional exercise therapy plus low-frequency pulse electrical stimulation (study group) according to the random number table method, with 55 cases in each. Clinical efficacy, muscle strength recovery, nerve conduction velocity (MCV), amplitude, wrist joint, and elbow joint activities of patients were analyzed and compared. Results: Patients with low frequency stimulation (LFS) showed significantly higher treatment effectiveness (89.09%) than those with exercise therapy only (69.09%). The incorporation of LFS with exercise therapy provided more enhancement in the muscle strength of wrist extensor and total finger extensor in patients when compared with a mere exercise intervention, suggesting better muscle function recovery of patients produced by LFS. Moreover, a significant increase in MCV and its amplitude was observed in all included patients, among which those receiving LFS showed a greater escalation of MCV and its amplitude. Following a treatment duration of 6 months, more patients in the LFS cohort were reported to achieve a wrist extension and elbow extension with an angle over 45° than the controls. There was no notable variance in adverse responses noted between the two patient groups. Conclusion: In patients afflicted with humerus shaft fracture and radial nerve injury, the amalgamation of exercise therapy with low-frequency pulse electrical stimulation can significantly improve clinical efficacy, promote nerve function, and muscle strength recovery, and features a high safety profile. Relevance to clinical practice: The combination of exercise therapy and low-frequency pulsed electrical stimulation can notably improve the promotion of neurologic function and muscle strength recovery in patients with humerus shaft fractures and radial nerve injuries with a high degree of safety.Clinical trial registration:https://www.researchregistry.com, identifier researchregistry9461.

A prospective observational study comparing outcomes application of low-frequency pulse electrical combined with target-oriented rehabilitation therapy in postoperative nerve function rehabilitation of patients with distal humeral fracture and radial nerve injury.

Objective: The aim of the present study was to compare the effect of low-frequency pulse electrical stimulation combined with target-oriented rehabilitation therapy and single low-frequency pulse electrical stimulation therapy on postoperative neurological improvement in patients with radial nerve injury and humeral condylar fracture. Methods: A total of 88 patients with humeral condyle fracture and radial nerve injury admitted to our hospital from April 2019 to January 2022 were randomly divided into a combined group and a control group, with 44 patients in each group. The patients in the combined group received low-frequency pulse electrical stimulation combined with target-oriented rehabilitation therapy, while those in the control group received low-frequency pulse electrical stimulation therapy. The recovery rate of radial nerve function, the recovery of finger extensor and wrist extensor muscle strength, and the occurrence of postoperative complications were evaluated in all patients. Results: After treatment, the recovery rate in the combined group (77.27%) was higher than that in the control group (50.00%) (p < 0.05). There was no significant difference in finger extensor and wrist extensor muscle strength before treatment between the two groups (p > 0.05). After treatment, both groups showed improvement compared to before treatment (p < 0.05), and the recovery in the combined group was better than that in the control group (p < 0.05). There was no significant difference in MCV and amplitude before treatment between the two groups (p > 0.05). After treatment, both groups showed improvement compared to before treatment (p < 0.05), and the recovery in the combined group was better than that in the control group (p < 0.05). The fracture healing time in the combined group was shorter than that in the control group (p < 0.05). During the treatment period, there was one case of infection and one case of joint pain in the combined group, with a complication rate of 4.55%. In the control group, there was one case of infection and two cases of joint pain, with a complication rate of 6.82%. There was no significant difference in the complication rate between the two groups (p > 0.05). The DHI score in the combined group was better than that in the control group (p < 0.05). The ESCA score in the combined group was better than that in the control group (p < 0.05). Conclusion: Low-frequency pulse electrical stimulation combined with target-oriented rehabilitation therapy can promote muscle strength and functional recovery after radial nerve injury, accelerate fracture healing time, and no additional risk of complications. Clinical trial registration: https://www.researchregistry.com/, researchregistry9461.

A Comparison of Anteromedial Plating Versus Anterolateral Plating for Humerus Shaft Fractures Using the Anterolateral Approach.

Background Plate osteosynthesis is the gold standard treatment for the management of humeral shaft fractures. In the present study, we performed plate osteosynthesis on the anteromedial and anterolateral surfaces using the anterolateral approach to compare the functional outcomes. Aims and objectives To study and compare the functional outcome, time to achieve union and associated complications of anteromedial and anterolateral plating in humerus shaft fracture by anterolateral approach. Methods This prospective, randomised control study was performed at Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India. This study had 46 patients in total, who were divided into two equal groups at random. All of the fractures in group A were treated using a limited contact dynamic compression plate (LCDCP) on the anterolateral surface using an anterolateral approach, while all of the fractures in group B were corrected using an anteromedial surface using an anterolateral approach using LCDCP. All the patients were followed for six months at regular intervals. At each follow-up, patients were assessed radiologically with X-rays and clinically by Rodriguez-Merchan criteria (RM criteria). Results and conclusions The union was achieved in the majority of the cases of the anteromedial plating group within 12 weeks (78.3%) with a mean union time of 11.7±1.5 weeks than the anterolateral group (56.5%) with a mean union time of 12.3±1.8 weeks. Based on functional assessment according to RM criteria, the excellent outcome was achieved in 69.6% and 65.2% of the anterolateral and anteromedial plating groups, respectively. There was no case of non-union and radial nerve palsy in anteromedial plating cases whereas in anterolateral cases one patient did not achieve union and two (8.7%) had radial nerve injury, which recovered completely by the end of the study. An anterolateral approach with anteromedial surface plating on the flat medial aspect of the humerus is a good technique for fixing humeral fractures.

Anconeus Muscle Transfer to Correct or Prevent Wrist Radial Deviation in Radial and Posterior Interosseous Nerve Injuries.

PURPOSE: Wrist radial deviation is a possible complication of tendon transfer for restoration of wrist extension in cases of radial nerve paralysis. In posterior interosseous nerve (PIN) injury, this is because of the imbalance caused by the intact extensor carpi radialis longus and paralysis of the extensor carpi ulnaris (ECU). This deformity may also occur following transfer of the pronator teres (PT) to the extensor carpi radialis brevis (ECRB) for radial nerve palsy. To address wrist radial deviation, we propose transferring the anconeus muscle, extended by the intermuscular septum between the ECU and the flexor carpi ulnaris (FCU), to the ECU tendon. METHODS: Through an incision over the ulna, the intermuscular septum between the ECU and FCU is harvested at the level of the periosteum and left attached to the anconeus proximally. The anconeus muscle is then released from the ulna, and the intramuscular septum extension is sutured to the ECU tendon under maximal tension. Anconeus muscle transfer was performed on two patients to correct chronic wrist radial deviation following PT to ECRB tendon transfer for radial nerve injury, as well as on two patients with PIN paralysis. In four patients, transfer was performed in addition to standard tendon transfers for radial nerve paralysis to prevent radial wrist deviation deformity. RESULTS: Wrist radial deviation was corrected or prevented in all but one patient at an average follow-up of 10 months. Patients with PIN lesions and those who had anconeus transfer concomitantly with radial nerve tendon transfers were capable of active ulnar deviation. No patient experienced elbow extension weakness, pain, or instability. CONCLUSIONS: Anconeus muscle transfer extended by intermuscular septum presents a viable alternative for addressing radial deviation of the wrist in cases of PIN nerve lesions or following PT to ECRB tendon transfer in radial nerve paralysis. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Fracturas supracondíleas humerales pediátricas. Comparación de dos técnicas de reducción / Pediatric humeral supracondylar fractures. Comparison of two reduction techniquesin

Resumen Objetivo: Analizar los resultados de la técnica quirúrgica de colocación de clavillos Kirschner forma lateral versus cruzada en el manejo de las fracturas supracondíleas de húmero en pacientes pediátricos. Metodología: Se captaron a todos los pacientes con fractura supracondílea humeral en edad pediátrica que requirieron intervención quirúrgica, y posteriormente fueron evaluados a las 24 horas y 6 meses posterior al tratamiento quirúrgico para observar y comparar las diferencias entre cada técnica quirúrgica utilizada, tomando en cuenta las complicaciones agudas y tardías que se presentaron mediante un análisis con la prueba de Mann-Whitney. Resultados: Para el presente estudios se evaluaron 44 pacientes pediátricos de los cuales 70% eran hombres y 30% mujeres, en quienes se presentaron complicaciones nerviosas y angulares sin importancia significativa alguna con el sexo y edades de los pacientes, siendo la afección del nervio cubital la de mayor frecuencia con 33% en la colocación de forma cruzada. Al realizar la comparativa con discriminación de variables se obtiene que la colocación de forma lateral presenta menos complicaciones posquirúrgicas tempranas y tardías y que tales no se deben al azar. Limitaciones o implicaciones: En el presente estudio no se incluyó el tipo de daño mecánico que provoca este tipo de fractura, ni se consideró el ángulo de Baumann. Otra limitación inherente en la población pediátrica es la habilidad del explorador para detectar un déficit neurológico, especialmente en pacientes de edad temprana dado a que los reportes de una exploración física siempre son subjetivos. Además, dada la limitación en cuanto a los detalles del mecanismo específico de daño, se puede subestimar el número de daños provocados por mecanismos de alta energía. Originalidad y valor: Su importancia radica en que ambas técnicas quirúrgicas fueron realizadas por los mismos cirujanos y que se trata de un estudio en población mexicana, siendo un aporte para la literatura de este país. Conclusión: Ambas técnicas quirúrgicas presentan resultados posquirúrgicos con casos de lesión nerviosa, deformidad angular, dolor y edema persistente, pero la que los presenta en menor frecuencia es la técnica de colocación de clavillos Kirschner en forma lateral, además de causar una significancia estadística en cuanto a la disminución de presentar cubito valgo en el seguimiento tardío de los pacientes.

Abstract: Objective: To analyze the results of the surgical technique placement of Kirschner pins lateral versus crossed in the management of supracondylar fractures of the humerus in pediatric patients. Methodology: All pediatric patients with humeral supracondylar fracture who required surgical intervention and were subsequently evaluated 24 hours and 6 months after surgical treatment to observe and compare the differences between each patient. surgical technique used. Taking into account the acute and late complications that occurred, through an analysis with the Mann-Whitney test. Results: For the present studies, 44 pediatric patients were evaluated, of whom 70% were men and 30% women, in whom nerve and angular complications presented without any significant importance with the sex and age of the patients, with ulnar nerve involvement being the most frequent with 33% in cross placement. When carrying out the comparison with discrimination of variables, it is obtained that the placement laterally presents fewer early and late post-surgical complications and that such are not due to chance. Or the present study, it is considered that a placement of Kirschner pins laterally regardless of the member, age, gender or classification; leads to better post-surgical results. Limitations or implications: In the present study, the type of mechanical damage that causes this type of fracture was not included, nor was the Baumann angle considered. Another limitation inherent in the pediatric population is the ability of the examiner to detect a neurological deficit, especially in young patients since reports of a physical examination are always subjective. Furthermore, given the limited details of the specific damage mechanism, the number of damages caused by high-energy mechanisms may be underestimated. Originality or value: Its importance lies in the fact that both surgical techniques were performed by the same surgeons and that it is a study in the mexican population, being a contribution to the literature of this country. Findings or conclusions: Both surgical techniques present post-surgical results with cases of nerve injury, angular deformity, pain and persistent edema, but the one that presents them less frequently in the technique of placement of Kirschner pins laterally, in addition to causing statistical significance in terms of the decrease of presenting cubitus valgus in the late follow-up of the patients.

Advantages of simultaneous radial nerve and tendon reconstruction - a case report.

Transection of the radial nerve is frequently associated with humeral shaft fractures that are part of a very complex upper extremity injury. In the presented case, a 19-year-old man with a 10-cm radial nerve defect with a need for nerve grafting to recover complete sensory and motor deficit of the radial nerve. In our case, at the same time we provided the tendon transfer of musculus (m.) pronator teres to m. extensor carpi radialis brevis, m. flexor carpi ulnaris to m. extensor digitorum communis, m. palmaris longus to m. extensor pollicis longus, and long sural nerve graft because of an extensive zone of the injury. The assumption was that if these two procedures are performed in one surgery, it will accelerate overall recovery, restore the functionality of the upper limb more quickly, and thus enable a faster recovery.

Simultaneous Bilateral Anterior Shoulder Dislocation After Low-Energy Trauma: A Case Report.

Unilateral shoulder dislocation is known to be one of the most common joint dislocations. However, simultaneous bilateral shoulder dislocations are rare, especially anterior dislocations. We report a case of an 84-year-old woman who presented to the urgency room with symmetrical bilateral anterior shoulder dislocation 12 hours after falling on a treadmill. She presented with bilateral pain, functional impairment, prominent acromion, flattened shoulder, and, in the right upper limb, paresthesias on the dorsum of the hand and extension deficit of the fingers. Closed reduction of both shoulders was performed under sedation, and she was immobilized bilaterally with an arm sling in internal rotation. A full recovery was achieved six months after the injury.

Humerus shaft fractures, approaches and management.

Humeral shaft fracture is a common injury which can be treated either conservatively with functional bracing or with surgical fixation. Current evidence shows an increase in the rate of nonunion after conservative treatment, suggesting that indications for conservative treatment may need to be re-examined. This article updates trends in treatment for humeral shaft fracture. Indications for surgery, both for plate osteosynthesis with open reduction and internal fixation (ORIF) as well as for minimally invasive plate osteosynthesis (MIPO) and intramedullary nailing (IMN) are described. Recognition of the advantages and disadvantages of each technique can better define the role of the plate or nail and can aid in the selection of an appropriate surgical approach. ORIF with compression plate continues to have a role in the treatment of simple or AO/OTA type A fractures. The primary goal of minimal invasive osteosynthesis, a surgical technique involving small incisions, closed reduction or mini-open reduction that minimizes soft tissue dissection and helps preserve the periosteal blood supply, is to achieve bone union and the best possible functional outcomes. MIPO of the humerus is now well accepted as being less invasive and providing relative stability to allow indirect (secondary) bone healing with callus formation. MIPO approaches can be performed circumferentially to the humerus, including the proximal, middle and distal shaft. The classic MIPO approach is anterior MIPO, followed by posterior, anterolateral and anteromedial MIPO. IMN is also an option for treating humerus fractures. In the past, IMN was not widely used due to the potential for complications such as shoulder impingement and elbow problems as well as the limited availability of implants and the steep learning curve of this surgical technique. Over the past decade, the launch of a new design of straight antegrade and retrograde IMN with established techniques has encouraged more surgeons to use IMN as an alternative option. Methods of dealing with concomitant and post-treatment radial nerve palsy have also been evolving, including the use of ultrasound for diagnosis of radial nerve conditions. Radial nerves with contusion, entrapment or laceration can be detected using ultrasound with reliability comparable to intraoperative findings. Trends in treatment of radial nerve palsy are described below. Future larger randomized controlled trials comparing conservative and operative management are necessary to further develop appropriate guidelines.

Case report: Pediatric floating elbow fracture with monteggia-equivalent lesion, ipsilateral humeral shaft fracture, and radial nerve injury: a unique case and favorable treatment outcomes.

This case report presents a rare and intricate pediatric floating elbow fracture involving a Monteggia-equivalent fracture, ipsilateral humeral shaft fracture, and radial nerve injury. The unique mechanism of injury highlights the importance of increased awareness and parental education for accident prevention. Elastic intramedullary nailing was employed for both humeral shaft and forearm fractures, leading to favorable outcomes. Despite the severity of the fractures and radial nerve injury, the prognosis was positive, with nerve function restoration and satisfactory functional recovery. However, the development of avascular necrosis of the radial head remains a challenge, emphasizing the need for further research to better understand and manage these uncommon and complex injuries.

Management of combat-sustained radial nerve injury during World War I: The case of Louis-Ferdinand Céline.

The radial nerve conveys sensory and motor information to and from the upper limb, and radial nerve injury can induce functional disability, as demonstrated by the case of the renowned French writer Louis-Ferdinand Céline (1894-1961), who sustained a gunshot injury to his right arm in October 1914. Radial nerve injuries treated during World War I inspired the publication of several medical handbooks and medical theses, such as that of the military surgeon Major Robert Bretton (1889-1956). The aim of this paper is, via Céline's injury, to explore the management of radial nerve injury during and since World War I. It is important to consider the historical perspective in order to improve radial nerve injury management so as to adapt to modern warfare.

Fractured Lateral Humeral Condyle Accompanied by Acute Radial Nerve Palsy in a Child: First Reported Case in the United Arab Emirates.

Despite being very common, lateral condyle fractures in children are rarely associated with acute nerve injuries. We present the case of a 10-year-old, left-handed male child who presented with a left lateral humeral condyle fracture associated with radial nerve injury. The patient was managed by open reduction and internal fixation plus radial nerve exploration, which was found entrapped in the fracture site. The patient achieved full recovery after 16 weeks. We report this case to present the approach and the operative findings and to emphasize the importance of a preoperative clinical examination in addition to preoperative planning to achieve a favorable outcome.

Anterior Shoulder Dislocation With an Ipsilateral Humeral Shaft Fracture: A Case Report.

Anterior shoulder dislocation is the most common type of shoulder dislocation but if accompanied by an ipsilateral humeral shaft fracture, it becomes extremely rare. There was no clear approach for dealing with these cases. We would like to present a case of a 17-year-old medically free male who was brought to the emergency department by ambulance after a road traffic accident. The patient was conscious, alert, and oriented. His Glasgow Coma Scale (GCS) was 15/15. He had multiple bruises all over his body with obvious swelling in his right arm with an inability to move the arm. There was tenderness over the right arm but an intact distal neurovascular exanimation. X-ray and CT scan showed anterior shoulder dislocation with an ipsilateral humeral shaft fracture of the right arm. There is no specific approach for such cases. However, open reduction with an intramedullary nail showed good outcomes with fewer postoperative neurovascular complications.

Outcomes and prognostic factors for nerve grafting following high radial nerve injury.

In this study, we examined the prognostic factors affecting outcomes following nerve grafting in high radial nerve injuries. Thirty-three patients with radial nerve injuries at a level distal to the first branch to the triceps and proximal to the posterior interosseous nerve were retrospectively studied. After a follow-up of at least 1 year, 24 patients (73%) obtained M3+ wrist extension, 16 (48%) obtained M3+ finger extension and only ten (30%) obtained M3+ thumb extension. Univariate, multivariate and receiver operating characteristic analyses showed that a delay in the repair of less than 6 months, a defect length of less than 5 cm or when grafted with three or more donor nerve cables achieved better recovery. Number of cables used was related to muscle strength recovery but not time to reinnervation. Nerve grafting for high radial nerve injury achieved relatively good wrist extension but poor thumb extension and is affected by certain prognostic factors. Level of evidence: IV.

Case Report: The unique case of flexible intramedullary nailing of pediatric radius complicated with temporary radial nerve's motor branch damage.

This study reported a case of radius flexible intramedullary nailing complicated by temporary paralysis of the posterior interosseous nerve due to compression of the ESIN on the nerve in an 8-year-old boy. The nerve damage resulted from an essential misconception at the surgery. Despite bad decisions made during qualifications and the procedure undertaken, restoring the nerve function, and gaining satisfactory functional fracture recovery was possible. Although it is generally acknowledged to perform retrograde flexible intramedullary nailing from the level of the distal radial metaphysis, the presentation of our case aims to emphasize the real risk of damage to the motor branch of the radial nerve when approaching the proximal metaphysis.

Radial Nerve Injury In Patients With Closed Fracture Of Humerus Shaft In High Energy Trauma Cases.

Background: Fracture of the humerus usually result in radial nerve injury. This study was done with the aim to determine the incidence of Radial Nerve Injury in patients with closed fracture of the humerus shaft in high-energy trauma cases. Methods: This descriptive study was conducted in the Department of Orthopaedics and Emergency room, Ghurki Teaching Hospital, Lahore from January to December 2021 recruiting consecutive such patients. Standard ward protocol was followed to manage the patients initially including fracture stabilization and analgesia requirement. All the patients were carefully assessed to detect radial nerve injury. Data analysis was done through SPSS 26.0. Results: A total of 80 patients were included with the confirmed diagnosis of fracture of the humerus. There were 55(68.5%) males and 25(31.25%) females. The age range was 20 to 60 years and the mean age of males and females was 31.62±8.35 and 38.43±5.06 respectively with overall mean age±SD was 38.93±6.19. There were 32 (40%) cases of spiral fracture, 17 (21.25%) cases of transverse fracture, 16 (20%) cases of communized fracture, and 15 (18.75%) cases of segmental fracture. Radial nerve injury was present in 7 (8.75%) patients. Out of these 7 cases of radial nerve injury; 4 (57.1%) cases were recorded in patients with spiral closed fracture of midshaft of humerus, 1 (14.3%) cases were recorded in transverse closed fracture of humerus shaft, 1(14.3%) cases in comminuted closed fracture of midshaft of the humerus while 1 (14.3%) were segmental fractures. Conclusion: Our study highlighted the frequency of radial nerve palsy in humeral shaft cases with most common in spiral closed fracture of the midshaft of the humerus.

Application of ultrasound in avoiding radial nerve injury during elbow arthroscopy: a retrospective follow-up study.

BACKGROUND: A safe and effective technique for anterolateral portal placement in elbow arthroscopy is significant. We compared the outcomes of patients who underwent elbow arthroscopy using different ultrasound-assisted techniques. METHODS: From May 2016 to June 2021 a retrospective analysis on all patients who underwent elbow arthroscopy in our department was performed. Patients were separated into three groups: non-ultrasound; preoperative ultrasound; and intraoperative ultrasound. The minimum follow-up period was 1 year. Nerve injuries, visual analog scale (VAS), Mayo elbow-performance score (MEPS), Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH), and range of motion (ROM) of the elbow were evaluated for comparison among the three groups pre- and post-operatively. RESULTS: All 55 patients completed a 1-year follow-up: non-ultrasound (n = 20); preoperative ultrasound (n = 17); and intraoperative ultrasound (n = 18). There were 3 cases (15.0%) of transient radial nerve palsy in the non-ultrasound group. No nerve complications occurred in preoperative ultrasound and intraoperative ultrasound groups. The probability of postoperative radial nerve injury in the three groups was statistically different (P < 0.05). There was no significant difference in the VAS score, MEPS, DASH score, and ROM among the three groups at the follow-up evaluation (P > 0.05). CONCLUSION: Performing anterolateral portal placement during elbow arthroscopy with ultrasound-assisted techniques successfully avoided radial nerve injury.

Pronator teres nerve branch transfer to the extensor carpi radialis brevis nerve branch for wrist extension reconstruction in proximal radial nerve injury following humeral shaft fractures.

BACKGROUND: Tendon and nerve transfers are used for functional reconstruction in cases of proximal radial nerve injury complicated by humeral fractures in patients who do not show functional recovery after primary nerve repair. The effectiveness of pronator teres (PT) nerve branch transfer to the extensor carpi radialis brevis (ERCB) nerve branch for wrist extension reconstruction was investigated and compared to the results of tendon transfer. METHODS: This study included 10 patients with proximal radial nerve injury, who did not show functional recovery after primary nerve repair at our hospital between April 2016 and May 2019. The nerve transfer procedure included PT nerve branch transfer to the ECRB nerve branch to restore wrist extension and the flexor carpi radialis (FCR) nerve branch to the posterior interosseous nerve (PIN) to restore thumb and finger extension. Tendon transfer procedures included PT transfer to the ECRB for wrist extension, FCR transfer to the extensor digitorum communis (EDC) for finger extension and palmaris longus (PL) transfer to the extensor pollicis longus (EPL) for thumb extension. RESULTS: Five patients recovered Medical Research Council grade M4 muscle strength in the ECRB and EPL in both tendon and nerve groups. Two patients recovered grade M3 strength and three patients recovered grade M4 strength in the EDC in the tendon transfer group, and all five patients recovered grade M4 strength in the EDC in the nerve transfer group. Limited wrist flexion was observed only in one patient in the tendon transfer group. CONCLUSION: PT nerve branch transfer to the ECRB nerve branch combined with FCR nerve branch transfer to PIN is a useful strategy for wrist and fingers extension reconstruction in patients with proximal radial nerve injuries.

An Analysis of the Structures at Risk from Percutaneous Pinning of Distal Radius Fractures and a Comparison of Two Pinning Techniques: A Cadaveric Study.

Background: A stab incision and blunt dissection prior to wire placement are believed to decrease the risk of injury to underlying structures during percutaneous pinning of distal radius fractures (DRF). However, only a few studies have compared stab incision and blunt dissection to direct wire placement. The aim of this cadaveric study is to analyse the structures at risk during percutaneous pinning of DRF and compare the two methods of wire placement. Methods: A total of 10 cadavers (20 upper limbs) were divided into two groups of five each. Five 2.0 mm Kirschner (K)-wires were inserted into the distal radius under fluoroscopic control in a standard fashion to simulate percutaneous pinning of DRF. In group 1, the K-wires were inserted directly, whereas in group 2, the wires were inserted after making a stab incision and blunt dissection to reach the bone. Each cadaveric limb was then dissected carefully to measure the distance of the K-wires from the branches of the superficial radial nerve (SRN), the cephalic vein and the first dorsal compartment and to determine the structures injured (pierced or in close contact) by the K-wires. Results: Out of the 100 K-wires placed, 18 wires were in close contact or pierced an underlying structure. These included 11 wires injuring tendons, six wires injuring branches of the SRN and one wire injuring the cephalic vein. Direct wire placement (group 1) resulted in injury to eight structures (44.4%) while stab incision and blunt dissection prior to wire placement (group 2) resulted in injury to 10 structures (55.5%). This difference was not statistically significant. Conclusions: Percutaneous pinning of DRF is associated with a high risk of injury to the extensor tendons and branches of the SRN. This risk is not reduced by making a stab incision and blunt dissection prior to K-wire placement.

Radial nerve trapped posterior to the proximal fracture end after closed reduction of supracondylar humerus fracture in children: A case report.

INTRODUCTION AND IMPORTANCE: Radial nerve injury is very common in supracondylar humerus fractures, but radial nerve entrapment between the fracture ends after closed reduction is very rare, and we report a case of radial nerve entrapment after closed reduction. CASE PRESENTATION: A 7-year-old boy was admitted to the Department of Pediatric Orthopedics 24 days after closed reduction of a supracondylar fracture of the humerus with radial nerve injury. Preoperative ultrasound showed radial nerve entrapment between the fracture ends, which was confirmed by surgery. After nerve release surgery, the radial nerve recovered well. CLINICAL DISCUSSION: How to treat supracondylar humerus fractures in case of nerve damage remains controversial. We presented a rare case with radial nerve injury after supracondylar humerus fracture caused complete motor palsy in which the main trunk of the radial nerve above the right elbow traveled posterior to the fracture site. Awareness of the status of the nerve before and after surgery can help in the clinical decision to perform a concomitant nerve exploration, and in the context of this, ultrasound may be more helpful. CONCLUSION: We recommend identifying the radial nerve using ultrasound during the closed reduction. If the nerve is entrapped between the fracture ends, exploration is recommended. For cases without entrapment, closed reduction with Kirschner wire fixation can be performed first, and the nerve should be re-examined with ultrasound.

Radial Nerve Injury in Humeral Shaft Fracture.

Radial nerve injury with humeral shaft fracture is common. Treatment options include expectant management, early exploration and repair, delayed reconstruction, nerve transfers, and tendon transfers. Knowledge of the appropriate application of these treatments will assist orthopedic surgeons and nerve surgeons in coordinating care for these patients.