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The standardized exploration of the radial nerve during humeral shaft fixation reduces the incidence of iatrogenic palsy

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The purpose of this study is to determine if a standardized protocol for radial nerve handling during humeral shaft repair reduces the incidence of iatrogenic nerve palsy post operatively.

Methods

Seventy-three patients were identified who underwent acute or reconstructive humeral shaft repair with radial nerve exploration as part of the primary procedure for either humeral shaft fracture or nonunion. All patients exhibited intact radial nerve function pre-operatively. A retrospective chart review and analysis identified patients who developed a secondary radial nerve palsy post-operatively. In each case, the radial nerve was identified and mobilized for protection, regardless of whether the implant necessitated the extensile exposure.

Results

Fractures were classified according to AO/OTA guidelines and included 23 Type 12A, 11 Type 12B, and 3 Type 12C. Eight patients had periprosthetic fractures and 28 fractures could not be classified. All patients in the cohort were fixed with locking plates. Surgery was indicated for 36 patients with humeral nonunions and 37 patients with acute humeral shaft fractures. Of the 73 patients, 2 (2.7%) developed radial nerve palsy following surgery, one from the posterior approach and one from the anterolateral approach. Both patients exhibited complete recovery of radial nerve function by 6-month follow-up. No significant differences (p > 0.05) were found in any demographic or surgical details between those with and without radial nerve injury.

Conclusions

Nerve exploration identification and protection leads to a low incidence of transient radial nerve palsy compared to the rate reported in the current literature (2.7% compared to 6–24%). Thus, radial nerve exploration and mobilization should be considered when approaching the humeral shaft for acute fracture and nonunion repairs.

Level of evidence

Level III.

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Acknowledgements

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Funding

There was no source of funding for this study.

Author information

Authors and Affiliations

  1. NYU Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, 10003, USA

    Rebekah Belayneh, Connor P. Littlefield, Sanjit R. Konda, Kari Broder, David N. Kugelman, Philipp Leucht & Kenneth A. Egol

  2. Jamaica Hospital Medical Center, Jamaica, NY, USA

    Sanjit R. Konda & Kenneth A. Egol

Authors
  1. Rebekah Belayneh
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  2. Connor P. Littlefield
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  3. Sanjit R. Konda
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  4. Kari Broder
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  5. David N. Kugelman
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  6. Philipp Leucht
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  7. Kenneth A. Egol
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Contributions

RB, SK, PL, and KE contributed to the study conception and design. Material preparation, data collection and analysis were performed by KB, CL, and DK. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kenneth A. Egol.

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The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the NYU School of Medicine Institutional Review Board and the Jamaica Hospital Medical Center Institutional Review Board.

Informed consent

This was a retrospective review of de-identified data, individual consents were not obtained.

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Belayneh, R., Littlefield, C.P., Konda, S.R. et al. The standardized exploration of the radial nerve during humeral shaft fixation reduces the incidence of iatrogenic palsy. Arch Orthop Trauma Surg 143, 125–131 (2023). https://doi.org/10.1007/s00402-021-04028-2

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  • DOI: https://doi.org/10.1007/s00402-021-04028-2

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