Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus

ÜNAL, Vuslat Sema; UÇANER, Ahmet; YILDIRIM, Ahmet Özgür; ÖKEN, Özdamar Fuad; Esmer, Ali Firat; Gulcek, Murat

Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus

Ahmet Özgür YILDIRIM, (Ankara Numune Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, Ankara, Türkiye)

Özdamar Fuad ÖKEN, (Ankara Numune Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, Ankara, Türkiye)

Vuslat Sema ÜNAL, (Acıbadem Maslak Hastanesi, Ortopedi ve Travmatoloji Kliniği, İstanbul, Türkiye)

Ali Fırat ESMER, (Ankara Üniversitesi, Tıp Fakültesi, Anatomi Anabilim Dalı, Ankara, Türkiye)

Murat GÜLCEK, (Ankara Numune Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, Ankara, Türkiye)

Ahmet UÇANER (Ankara Numune Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği, Ankara, Türkiye)

Acta Orthopaedica et Traumatologica Turcica

18 0

Yıl: 2012 Cilt: 46 Sayı: 1 Sayfa Aralığı: 8 - 12 Metin Dili: İngilizce İndeks Tarihi: 29-07-2022

Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus

Öz:

Objective: Our aim was to assess the results of posterior retraction technique to prevent iatrogenic radial nerve injury during humeral fracture surgery. Methods: Seventy-two patients who underwent surgery for a distal humerus fracture between 1996 and 2002 were reviewed. These 72 patients comprised Group 1. Following a cadaveric study on the vascularization of the radial nerve, a modified surgical approach was undertaken starting in 2002. Sixty-one patients who underwent this new surgical approach were included in Group 2. The rates of radial nerve deficit of the groups were compared using the Pearson chi-square test. Results: In Group 1, 19 iatrogenic nerve deficits occurred. After defining the blood circulation of the nerve, the lateral approach was modified. The anterolateral side of the nerve was released and the nerve was left attached to the triceps muscle. In Group 2, one patient developed postoperative transient nerve deficit. Conclusion: The radial nerve is supplied by the branches of the deep brachial artery in close relation with the triceps muscle. Anterior dissection and posterior retraction of the radial nerve during lateral approach may preserve its blood supply and reduces the risk of iatrogenic injury

Anahtar Kelime:

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Bibliyografik

1. Wang JP, Shen WJ, Chen WM, Huang CK, Shen YS, Chen TH. Iatrogenic radial nerve palsy after operative management of humeral shaft fractures. J Trauma 2009;66:800-3.
2. DeFranco MJ, Lawton JN. Radial nerve injuries associated with humeral fractures. J Hand Surg Am 2006;31:655-63.
3. Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvsit H, Ponzer S. Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J Bone Joint Surg B 2006;88: 1469-73.
4. Yakkanti MR, Roberts CS, Murphy J, Acland RD. Anterior transposition of the radial nerve a cadaveric study. J Orthop Trauma 2008;22:705-8.
5. El-Barrany WG, Marei AG, Vallée B. Anatomic basis of vascularised nerve grafts: the blood supply of peripheral nerves. Surg Radiol Anat 1999;21:95-102.
6. Fleming P, Lenehan B, Sankar R, Folan-Curran J, Curtin W. One-third, two-thirds: relationship of the radial nerve to the lateral intermuscular septum in the arm. Clin Anat 2004;17: 26-9.
7. Carlan D, Pratt J, Patterson JM, Weiland AJ, Boyer MI, Gelberman RH. The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg Am 2007;32:1172- 82.
8. King A, Johnston GH. A modification of Henrys anterior approach to the humerus. J Shoulder Elbow Surg 1998;7:210- 2.
9. Mekhail AO, Checroun AJ, Ebraheim NA, Jackson WT, Yeasting RA. Extensile approach to the anterolateral surfaceof the humerus and the radial nerve. J Shoulder Elbow Surg 1999;8:112-8.
10. Mills WJ, Hanel DP, Smith DG. Lateral approach to the humeral shaft: an alternative approach for the fracture treatment. J Orthop Trauma 1996;10:81-6.
11. Zlotolow DA, Catalano LW 3rd, Barron OA, Glickel SZ. Surgical exposures of the humerus. J Am Acad Orthop Surg 2006;14:754-65.
12. Bono CM, Grossman MG, Hochwald N, Tornetta P 3rd. Radial and axillary nerves. Anatomic considerations for humeral fixation. Clin Orthop Relat Res 2000;(373):259-64.
13. Gerwin M, Hotchkiss RN, Weiland AJ. Alternative operative exposures of the posterior aspect of the humeral diaphysis with reference to the radial nerve. J Bone Joint Surg Am 1996;78: 1690-5.
14. ODriscoll. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 2005;14(1 Suppl S):186S-194S.
15. Uhl RL, Larosa JM, Sibeni T, Martino LJ. Posterior approaches of the humerus: when should you worry about the radial nerve? J Orthop Trauma 1996;10:338-40.
16. Ring D, Chin K, Jupiter JB. Radial nerve palsy associated with high-energy humeral shaft fractures. J Hand Surg Am 2004; 29:144-7.

APA	YILDIRIM A, ÖKEN Ö, ÜNAL V, Esmer A, Gulcek M, UÇANER A (2012). Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. , 8 - 12.
Chicago	YILDIRIM Ahmet Özgür,ÖKEN Özdamar Fuad,ÜNAL Vuslat Sema,Esmer Ali Firat,Gulcek Murat,UÇANER Ahmet Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. (2012): 8 - 12.
MLA	YILDIRIM Ahmet Özgür,ÖKEN Özdamar Fuad,ÜNAL Vuslat Sema,Esmer Ali Firat,Gulcek Murat,UÇANER Ahmet Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. , 2012, ss.8 - 12.
AMA	YILDIRIM A,ÖKEN Ö,ÜNAL V,Esmer A,Gulcek M,UÇANER A Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. . 2012; 8 - 12.
Vancouver	YILDIRIM A,ÖKEN Ö,ÜNAL V,Esmer A,Gulcek M,UÇANER A Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. . 2012; 8 - 12.
IEEE	YILDIRIM A,ÖKEN Ö,ÜNAL V,Esmer A,Gulcek M,UÇANER A "Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus." , ss.8 - 12, 2012.
ISNAD	YILDIRIM, Ahmet Özgür vd. "Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus". (2012), 8-12.

APA	YILDIRIM A, ÖKEN Ö, ÜNAL V, Esmer A, Gulcek M, UÇANER A (2012). Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. Acta Orthopaedica et Traumatologica Turcica, 46(1), 8 - 12.
Chicago	YILDIRIM Ahmet Özgür,ÖKEN Özdamar Fuad,ÜNAL Vuslat Sema,Esmer Ali Firat,Gulcek Murat,UÇANER Ahmet Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. Acta Orthopaedica et Traumatologica Turcica 46, no.1 (2012): 8 - 12.
MLA	YILDIRIM Ahmet Özgür,ÖKEN Özdamar Fuad,ÜNAL Vuslat Sema,Esmer Ali Firat,Gulcek Murat,UÇANER Ahmet Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. Acta Orthopaedica et Traumatologica Turcica, vol.46, no.1, 2012, ss.8 - 12.
AMA	YILDIRIM A,ÖKEN Ö,ÜNAL V,Esmer A,Gulcek M,UÇANER A Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. Acta Orthopaedica et Traumatologica Turcica. 2012; 46(1): 8 - 12.
Vancouver	YILDIRIM A,ÖKEN Ö,ÜNAL V,Esmer A,Gulcek M,UÇANER A Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus. Acta Orthopaedica et Traumatologica Turcica. 2012; 46(1): 8 - 12.
IEEE	YILDIRIM A,ÖKEN Ö,ÜNAL V,Esmer A,Gulcek M,UÇANER A "Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus." Acta Orthopaedica et Traumatologica Turcica, 46, ss.8 - 12, 2012.
ISNAD	YILDIRIM, Ahmet Özgür vd. "Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus". Acta Orthopaedica et Traumatologica Turcica 46/1 (2012), 8-12.