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Transfracture medial transposition of the radial nerve associated with plate fixation of the humerus

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Abstract

Purpose

The aim of this study was to illustrate safety, feasibility and advantages of transfracture medial transposition of the radial nerve during the lateral approach and lateral plating of humeral fractures located in the mid and distal shaft.

Methods

This was a retrospective review and analysis of medical records and radiographs of 19 patients who underwent a transfracture medial transposition of the radial nerve. Fifteen patients were treated for fresh fracture and four for nonunion. All patients were followed up clinically and radiographically for a minimum of 12 months.

Results

Pre-operative radial nerve paralysis was present in four patients in the fresh fractures group; post-operative paralysis occurred in two. All patients completely recovered a few months after the index procedure. Except for two, all patients achieved bone healing. One patient from the fresh-fracture group developed nonunion, and one from the nonunion group experienced persistent nonunion; both underwent successful revision surgeries. In addition, four patients with a fresh fracture underwent revision surgery for hardware removal. All but two patients showed no restricted elbow or shoulder joint motion compared with the opposite side.

Conclusion

Transfracture transposition of the radial nerve during open reduction and internal fixation of humeral shaft fractures is a safe, harmless and feasible procedure when applied for fractures of the middle and distal humeral shaft; it removes the nerve from the surgical field during fracture manipulation and fixation, with a gain in length of the nerve by transforming its course from spiral to straight. Following radial nerve transposition across the fracture, a repeat surgical approach to the humerus for hardware removal or treatment of nonunion transforms the procedure into a simple one; the skin incision is carried straight down to the bone without the need to identify or dissect the nerve that was previously transposed to the medial compartment of the arm.

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Authors and Affiliations

  1. Division of Orthopaedic and Trauma Surgery, Faculty of Medical Sciences, Lebanese University, Hadat, Beirut, Lebanon

    Ali Hassan Chamseddine, Amer Abdallah & Hadi Zein

  2. Division of Orthopaedic and Trauma surgery, Sahel General Hospital. University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon

    Ali Hassan Chamseddine & Hadi Zein

  3. Division of Orthopaedic surgery, American University of Beirut Medical Centre, Beirut, Lebanon

    Assad Taha

Authors
  1. Ali Hassan Chamseddine
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  2. Amer Abdallah
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  3. Hadi Zein
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  4. Assad Taha
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Correspondence to Ali Hassan Chamseddine.

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Chamseddine, A.H., Abdallah, A., Zein, H. et al. Transfracture medial transposition of the radial nerve associated with plate fixation of the humerus. International Orthopaedics (SICOT) 41, 1463–1470 (2017). https://doi.org/10.1007/s00264-016-3397-7

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  • DOI: https://doi.org/10.1007/s00264-016-3397-7

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