Abstract
Despite advances in instrumentation and technology, complications still exist in orthopaedic practice and neurologic and vascular injuries remain an inherent part of many procedures. At arm and elbow level one of the most severe, even if unfrequent, complications is a iatrogenic nerve injury, for the relevant impairment to the upper limb function in terms of motility but also of sensibility. Various surgical procedures around the elbow and arm are known to involve a risk of vascular and/or peripheral nerve lesions. At arm level one of the major risks is a radial nerve palsy during the treatment of humerus fractures. The decision on nerve exploration and its timing is still controversial. At elbow level the development of sophisticated arthroscopic procedures and the more and more frequent implant of elbow prosthesis augment the risks of neurological damage in a surgical region difficult for the proximity of important nerve structures to the surgical approaches.
It is essential to know well the risks associated with each procedure to prevent them in the most appropriate manner. If a vascular or neurological injury is created by the surgical procedure it has to be opportunely identified and treated.
Similar content being viewed by others
Bibliografia
Spiguel AR, Steffner RJ (2012) Humeral shaft fractures. Curr Rev Musculoskelet Med 5:177–183
Elton SG, Rizzo M (2008) Management of radial nerve injury associated with humeral shaft fractures: an evidence-based approach. J Reconstr Microsurg 24:569–574
Ekholm R, Adami J, Tidermark J et al. (2006) Fractures of the shaft of the humerus: an epidemiological study of 401 fractures. J Bone Jt Surg Br 88:1469–1473
Tytherleigh-Strong G, Walls N, McQueen MM (1998) The epidemiology of humeral shaft fractures. J Bone Jt Surg Br 80:249–253
Noble J, Munro CA, Prasad VS, Midha R (1998) Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma 45:116–122
Holstein A, Lewis GM (1963) Fractures of the humerus with radial-nerve paralysis. J Bone Jt Surg Am 45:1382–1388
Chamseddine AH, Zein HK, Alasiry AA et al. (2013) Trans-fracture transposition of the radial nerve during the open approach of humeral shaft fractures. Eur J Orthop Surg Traumatol 23:725–730
El Ayoubi L, Karmouta A, Roussignol X et al. (2003) Transposition antérieure du nerf radial dans les fractures du 1/3 moyen de l’humérus: bases anatomiques et applications cliniques. Rev Chir Orthop Reparatrice Appar Mot 89:537–543
Paris H, Tropiano P, Clouet D’Orval B et al. (2000) Fracture diaphysaire de l’humérus: ostéosynlhèse systématique par plaque. Rev Chir Orthop Reparatrice Appar Mot 86:346–359
Shaw JL, Sakellarides H (1967) Radial-nerve paralysis associated with fractures of the humerus. A review of forty-five cases. J Bone Jt Surg Am 49:899–902
Friedman RJ, Smith RJ (1984) Radial-nerve laceration twenty six years after screw fìxation of a humeral fracture. A case report. J Bone Jt Surg Am 66:959–960
Carroll EA, Schweppe M, Langfitt M et al. (2012) Management of humeral shaft fractures. J Am Acad Orthop Surg 20:423–433
Walker M, Palumbo B, Badman B et al. (2011) Humeral shaft fractures: a review. J Shoulder Elbow Surg 20:833–844
Lin J, Hou SM (2003) Locked nailing of severely comminuted or segmental humeral fractures. Clin Orthop Relat Res 406:195–204
Lowe JB 3rd, Sen SK, Mackinnon SE (2002) Current approach to radial nerve paralysis. Plast Reconstr Surg 110:1099–1113
Shah JJ, Bhatti NA (1983) Radial nerve paralysis associated with fractures of the humerus. A review of 62 cases. Clin Orthop Relat Res 172:171–176
Postacchini F, Morace GB (1988) Fractures of the humerus associated with paralysis of the radial nerve. Ital J Orthop Traumatol 14:455–464
Bodner G, Huber B, Schwabegger A et al. (1999) Sonographic detection of radial nerve entrapment within a humerus fracture. J Ultrasound Med 18:703–706
Bodner G, Buchberger W, Schocke M et al. (2001) Radial nerve palsy associated with humeral shaft fracture: evaluation with US—initial experience. Radiology 219:811–816
Shao YC, Harwood P, Grotz MR et al. (2005) Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J Bone Jt Surg Br 87:1647–1652
Ingari JV, Green DP (2011) Radial nerve palsy. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH (eds) Green’s operative hand surgery, vol 2. Churcill Livingstone, New York, pp 1075–1092
Seddon HJ (1963) Nerve grafting. J Bone Jt Surg Br 45:447–461
Garcia A Jr, Maeck BH (1960) Radial nerve injuries in fractures of the shaft of the humerus. Am J Surg 99:625–627
Böstman O, Bakalim G, Vainionpää S et al. (1986) Radial palsy in shaft fracture of the humerus. Acta Orthop Scand 57:316–319
Noaman H, Khalifa AR, El-Deen MA, Shiha A (2008) Early surgical exploration of radial nerve injury associated with fracture shaft humerus. Microsurgery 28:635–642
Amillo S, Barrios RH, Martínez-Peric R, Losada JI (1993) Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma 7:211–215
Pollock FH, Drake D, Bovill EG et al. (1981) Treatment of radial neuropathy associated with fractures of the humerus. J Bone Jt Surg Am 63:239–243
Millesi H, Meissl G, Berger A (1972) The interfascicular nerve-grafting of the median and ulnar nerves. J Bone Jt Surg Am 54:727–750
Nunley JA, Saies AD, Sandow MJ, Urbaniak JR (1996) Results of interfascicular nerve grafting for radial nerve lesions. Microsurgery 17:431–437
Sunderland S (1991) Decision making in clinical management of nerve injury and repair. In: Sunderland S (ed) Nerve injuries and their repair. Churchill Livingstone, Edinburgh, pp 413–431
Burkhalter WE (1974) Early tendon transfer in upper extremity peripheral nerve injury. Clin Orthop Relat Res 104:68–79
Vazquez O, Rutgers M, Ring DC et al. (2010) Fate of the ulnar nerve after operative fixation of distal humerus fractures. J Orthop Trauma 24:395–399
Huang TL, Chiu FY, Chuang TY, Chen TH (2005) The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results. J Trauma 58:62–69
McCarty LP, Ring D, Jupiter JB (2005) Management of distal humerus fractures. Am J Orthop 34:430–438
Webb LX (2001) Fractures of the distal humerus. In: Bucholz RW, Heckman JD (eds) Rockwood and Green’s fractures in adults. Lippincott Williams & Wilkins, Philadelphia, pp 953–972
Helfet DL, Kloen P, Anand N, Rosen HS (2003) Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. J Bone Jt Surg Am 85:33–40
Ring D, Gulotta L, Chin K, Jupiter JB (2004) Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma 18:446–449
McKee MD, Wilson TL, Winston L et al. (2000) Functional outcome following surgical treatment of intra-articular distal humerus fractures through a posterior approach. J Bone Jt Surg Am 82:1701–1707
Worden A, Ilyas AM (2012) Ulnar neuropathy following distal humerus fracture fixation. Orthop Clin N Am 43:509–514
Athwal G, Hoxie S, Rispoli D, Steinmann SP (2009) Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures. J Orthop Trauma 23:575–580
Guner S, Guven N, Karadas S et al. (2013) Iatrogenic or fracture-related nerve injuries in supracondylar humerus fracture: is treatment necessary for nerve injury? Eur Rev Med Pharmacol Sci 17:815–819
Landi et al. (1991) Neurovascular complications in the post-traumatic elbow. In: Celli L (ed) The elbow-traumatic lesions, vol 2. Springer, Wien, pp 127–137
Prasarn ML, Ouellette EA (2011) Acute compartment syndrome of the upper extremity. J Am Acad Orthop Surg 19:49–58
Antuña SA, Morrey BF, Adams RA, O’Driscoll SW (2002) Ulnohumeral arthroplasty for primary degenerative arthritis of the elbow: long-term outcome and complications. J Bone Jt Surg Am 84:2168–2173
Kaplan EB (1941) Surgical approach to the proximal end of the radius and its use in fractures of the head and neck of the radius. J Bone Jt Surg Am 23:86–92
Park MJ, Chang MJ, Lee YB, Kang HJ (2010) Surgical release for posttraumatic loss of elbow flexion. J Bone Jt Surg Am 92:2692–2699
Mansat P, Morrey BF (1998) The column procedure: a limited lateral surgical approach for extrinsic contracture of the elbow. J Bone Jt Surg Am 80:1603–1615
Ewald FC, Scheinberg RD, Poss R et al. (1980) Capitellocondylar total elbow arthroplasty. J Bone Jt Surg Am 62:1259–1263
Trancik T, Wilde AH, Borden LS (1987) Capitellocondylar total elbow arthroplasty. Two- to eight-year experience. Clin Orthop Relat Res 223:175–180
Bayley JI (1981) Elbow replacement in rheumatoid arthritis. Reconstr Surg Traumatol 18:70–83
Gschwend N, Simmen BR, Matejovsky Z (1996) Late complications in elbow arthroplasty. J Shoulder Elbow Surg 5:86–96
Malone AA, Zarkadas P, Jansen S, Hughes JS (2009) Elbow hemiarthroplasty for intra-articular distal humeral fracture. J Bone Jt Surg Br 91(Suppl 2):256
Voloshin I, Schippert DW, Kakar S et al. (2011) Complications of total elbow replacement: a systematic review. J Shoulder Elbow Surg 20:158–168
Hodgson SP, Parkinson RW, Noble J (1991) Capitellocondylar total elbow replacement for rheumatoid arthritis. J R Coll Surg Edinb 36:133–135
Good AE, Christopher RP, Koepke GH et al. (1965) Peripheral neuropathy associated with rheumatoid arthritis. A clinical and electrodiagnostic study of 70 consecutive rheumatoid arthritis patients. Ann Intern Med 63:87–99
Upton AR, Darracott J, Bianchi FA (1978) Ulnar neuropathies in rheumatoid arthritis. Hand 10:77–81
Pallis CA, Scott JT (1965) Peripheral neuropathy in rheumatoid arthritis. BMJ 1:1141–1147
Spinner RJ, Morgenlander JC, Nunley JA (2000) Ulnar nerve function following total elbow arthroplasty: a prospective study comparing preoperative and postoperative clinical and electrophysiologic evaluation in patients with rheumatoid arthritis. J Hand Surg Am 25:360–364
Throckmorton TW, Zarkadas PC, Sanchez-Sotelo J, Morrey BF (2011) Radial nerve palsy after humeral revision in total elbow arthroplasty. J Shoulder Elbow Surg 20:199–205
Jones GS, Savoie FH 3rd (1993) Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow. Arthroscopy 9:277–283
Lynch GH, Meyers JF, Whipple TL, Caspari RB (1986) Neurovascular anatomy and elbow arthroscopy: inherent risks. Arthroscopy 2:190–197
Papilion JD, Neff RS, Shall LM (1988) Compression neuropathy of the radial nerve as a complication of elbow arthroscopy: a case report and review of the literature. Arthroscopy 4:284–286
Thomas MA, Fast A, Shapiro D (1987) Radial nerve damage as a complication of elbow arthroscopy. Clin Orthop Relat Res 215:130–131
Andrews JR, Carson WG (1985) Arthroscopy of the elbow. Arthroscopy 1:97–107
Conflitto di interesse
Nessuno.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Battiston, B., Titolo, P., Mellano, D. et al. Le lesioni vascolo-nervose nei trattamenti ortopedici a livello di braccio e gomito. LO SCALPELLO 28, 24–31 (2014). https://doi.org/10.1007/s11639-014-0064-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11639-014-0064-x