Date: 26 Aug 2010
Use of Ultrasound in Detection and Treatment of Nerve Compromise in a Case of Humeral Lengthening
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The development of iatrogenic nerve lesions during and following limb lengthening procedures present a challenge to orthopedic surgeons. Early treatment of nerve damage is critical in salvaging full function of the nerve. Precise location of damage, however, must be determined in order to appropriately administer treatment. We report a patient with a short humerus caused by a growth arrest undergoing a 7-cm lengthening who developed a neurapraxic injury of the radial nerve. Nerve compromise was noted 1 month into the lengthening program. Nerve conduction studies and electromyography could not be used to determine the precise site of injury. Likewise, magnetic resonance imaging and computed tomography were contraindicated and inconclusive, respectively, due to the presence of a metallic external fixation device. High-resolution ultrasonography (US) findings, however, correlated with our clinical examination of the patient's radial nerve function and permitted identification of the precise site of nerve involvement. Treatment was administered by removing a causative half-pin. Several days following treatment, nerve function returned to normal. There are a limited number of articles in the literature regarding nerve injuries associated with limb lengthening and their corrective treatments. The outcome of this case underscores the usefulness of US over various other diagnostic techniques under certain circumstances.
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained.
Atar D, Lehman WB, Grant AD, Strongwater A, Frankel V, Golyakhovsky V. Treatment of complex limb deformities in children with the Ilizarov technique. Orthopedics. 1991;14:961–967.PubMed
Bodner G, Huber B, Schwabegger A, Lutz M, Waldenberger P. Sonographic detection of radial nerve entrapment within a humerus fracture. J Ultrasound Med. 1999;18:703–706.PubMed
Cokluk C, Aydin K. Ultrasound examination in the surgical treatment for upper extremity peripheral nerve injuries: part I. Turk Neurosurg. 2007;17:277–282.PubMed
Cokluk C, Aydin K. Ultrasound examination in the surgical treatment of lower extremity peripheral nerve injuries: part II. Turk Neurosurg. 2007;17:197–201.PubMed
Coleman SS, Stevens PM. Tibial lengthening. Clin Orthop Relat Res. 1978;(136):92–104.PubMed
Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clin Orthop Relat Res. 1994;(301):10–18.PubMed
Eldridge JC, Bell DF. Problems with substantial limb lengthening.Orthop Clin North Am. 1991;22:625–631.PubMed
Fornage BD. Sonography of peripheral nerves of the extremities. Radiol Med. 1993;85:162–167.PubMed
Foxall GL, Skinner D, Hardman JG, Bedforth NM. Ultrasound anatomy of the radial nerve in the distal upper arm. Reg Anesth Pain Med. 2007;32:217–220.PubMed
Galardi G, Comi G, Lozza L, Marchettini P, Novarina M, Facchini R, Paronzini A. Peripheral nerve damage during limb lengthening. Neurophysiology in five cases of bilateral tibial lengthening. J Bone Joint Surg Br. 1990;72:121–124.PubMed
Karabay N, Toros T, Ademoglu Y, Ada S. Ultrasonographic evaluation of the iatrogenic peripheral nerve injuries in upper extremity. Eur J Radiol. 2008. (in press).
Nogueira MP. Obstacles in limb lengthening: Nerve problems. In: Rozbruch SR, Ilizarov S, eds. Limb lengthening and reconstruction surgery. New York: Informa Healthcare; 2007:669–675.
Nogueira MP, Paley D, Bhave A, Herbert A, Nocente C, Herzenberg JE. Nerve lesions associated with limb-lengthening. J Bone Joint Surg Am. 2003;85-A:1502–1510.PubMed
Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res. 1990;(250):81–104.PubMed
Peer S, Bodner G, Meirer R, Willeit J, Piza-Katzer H. Examination of postoperative peripheral nerve lesions with high-resolution sonography. AJR Am J Roentgenol. 2001;177:415–419.PubMed
Velazquez RJ, Bell DF, Armstrong PF, Babyn P, Tibshirani R. Complications of use of the Ilizarov technique in the correction of limb deformities in children. J Bone Joint Surg Am. 1993;75:1148–1156.PubMed
- Use of Ultrasound in Detection and Treatment of Nerve Compromise in a Case of Humeral Lengthening
Volume 7, Issue 1 , pp 80-84
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- humeral lengthening
- monolateral frame
- distraction osteogenesis
- Author Affiliations
- 1. Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery,, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
- 3. Weill Cornell Medical College, New York, NY, 10065, USA
- 2. Department of Radiology and Imaging,, Hospital for Special Surgery, New York, NY, 10021, USA