Treatment of Iatrogenic Nerve Injury After Humeral Shaft Fracture Fixation: A Case Report
- Authors: Kisel D.A.1, Fain A.M.1,2, Svetlov K.V.1, Bogolyubsky Y.A.1, Aleynikova I.B.1, Sinkin M.V.1
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Affiliations:
- N.V. Sklifosovsky Research Institute for Emergency Medicine
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
- Issue: Vol 29, No 3 (2023)
- Pages: 110-117
- Section: Case Reports
- URL: https://ogarev-online.ru/2311-2905/article/view/255270
- DOI: https://doi.org/10.17816/2311-2905-7984
- ID: 255270
Cite item
Abstract
Background. Iatrogenic neuropathies of the radial nerve following intramedullary nailing of the humerus are observed in 2.9% of patients. In 30% of cases, iatrogenic nerve injury is associated with distal nail locking. Questions about the timing and volume of diagnostic measures to determine the nature of nerve damage, methods of conservative and surgical treatment, and their effectiveness remain relevant.
Aim of the study — to illustrate the causes, prevention methods, diagnosis, and treatment of iatrogenic radial nerve injuries in humeral shaft fractures through a clinical example.
Case presentation. A 30-year-old female patient was admitted with a nonunion fracture of the left humerus and iatrogenic radial nerve injury three months after the fracture was fixed with a locking nail. A revision operation was performed: removal of the nail from the left humerus; re-fixation of the left humerus with a plate; revision, neurolysis, and plastic repair of the left radial nerve using autografts from the right sural nerve. Postoperative courses of medication therapy, physiotherapy, and therapeutic exercises were conducted. At 26 months after the surgery, complete range of motion and restoration of strength in active extension of the left wrist and three phalanges, abduction of the first finger, partial extension of the first finger, and restoration of sensitivity on the outer surface of the left forearm and the back of the hand were observed.
Conclusion. Iatrogenic radial nerve injury primarily occurs as a result of incorrect technique when introducing locking screws during intramedullary nailing of humeral shaft fractures. Delayed examination and surgical treatment of patients with injured radial nerve lead to a lack of full functional recovery, potential muscle atrophy, and impairment of their motor function. Surgical treatment aimed at restoring the radial nerve at an early stage after injury, combined with a full range of postoperative rehabilitation for a year, is the only correct treatment approach.
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##article.viewOnOriginalSite##About the authors
Dmitry A. Kisel
N.V. Sklifosovsky Research Institute for Emergency Medicine
Author for correspondence.
Email: dkis@yandex.ru
ORCID iD: 0000-0002-5187-0669
SPIN-code: 7663-4031
plastic surgeon, research scientist of trauma surgery
Russian Federation, 3, Bolshaya Sukharevskaya Sq., Moscow, 129090Alexey M. Fain
N.V. Sklifosovsky Research Institute for Emergency Medicine; A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Email: finn.loko@mail.ru
ORCID iD: 0000-0001-8616-920X
Dr. Sci. (Med.), head of trauma surgery N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Health Department. Professor of the Department of Traumatology of the A.I. Yevdokimov Moscow State University of Medicine and Dentistry
Russian Federation, 3, Bolshaya Sukharevskaya Sq., Moscow, 129090; MoscowKirill V. Svetlov
N.V. Sklifosovsky Research Institute for Emergency Medicine
Email: svetloffkirill@yandex.ru
ORCID iD: 0000-0002-1538-0515
Cand. Sci. (Med.), leading researcher of trauma surgery
Russian Federation, 3, Bolshaya Sukharevskaya Sq., Moscow, 129090Yuri A. Bogolyubsky
N.V. Sklifosovsky Research Institute for Emergency Medicine
Email: bo_y_an@mail.ru
ORCID iD: 0000-0002-1509-7082
Cand. Sci. (Med.), senior research fellow of trauma surgery
Russian Federation, 3, Bolshaya Sukharevskaya Sq., Moscow, 129090Irina B. Aleynikova
N.V. Sklifosovsky Research Institute for Emergency Medicine
Email: alejnikova_irina@mail.ru
ORCID iD: 0000-0003-4937-0400
Cand. Sci. (Med.), functional diagnostics doctor, neurosurgeon
Russian Federation, 3, Bolshaya Sukharevskaya Sq., Moscow, 129090Mikhail V. Sinkin
N.V. Sklifosovsky Research Institute for Emergency Medicine
Email: mvsinkin@gmail.com
ORCID iD: 0000-0001-5026-0060
Dr. Sci. (Med.), senior research fellow, functional diagnostics doctor
Russian Federation, 3, Bolshaya Sukharevskaya Sq., Moscow, 129090References
- Laulan J. High radial nerve palsy. Hand Surg Rehabil. 2019;38(1):2-13. doi: 10.1016/j.hansur.2018.10.243.
- Bumbasirevic M., Palibrk T., Lesic A., Atkinson H.D. Radial nerve palsy. EFORT Open Rev. 2017;1(8):286-294. doi: 10.1302/2058-5241.1.000028.
- Cognet J.M., Fabre T., Durandeau A. Persistent radial palsy after humeral diaphyseal fracture: cause, treatment, and results. 30 operated cases. Rev Chir Orthop Reparatrice Appar Mot. 2002;88(7):655-662. (In French).
- Ljungquist K.L., Martineau P., Allan C. Radial nerve injuries. J Hand Surg Am. 2015;40(1):166-172. doi: 10.1016/j.jhsa.2014.05.010.
- Rasulić L., Djurašković S., Lakićević N., Lepić M., Savić A., Grujić J. et al. Surgical Treatment of Radial Nerve Injuries Associated With Humeral Shaft Fracture-A Single Center Experience. Front Surg. 2021;8:774411. doi: 10.3389/fsurg.2021.774411.
- Schwaiger K., Abed S., Russe E., Koeninger F., Wimbauer J., Kholosy H. et al. Management of Radial Nerve Lesions after Trauma or Iatrogenic Nerve Injury: Autologous Grafts and Neurolysis. J Clin Med. 2020;9(12):3823. doi: 10.3390/jcm9123823. 7.
- Chang G., Ilyas A.M. Radial Nerve Palsy After Humeral Shaft Fractures: The Case for Early Exploration and a New Classification to Guide Treatment and Prognosis. Hand Clin. 2018;34(1):105-112. doi: 10.1016/j.hcl.2017.09.011.
- Вишневский В.А. Причины, диагностические ошибки при повреждениях периферических нервов конечностей. Запорожский медицинский журнал. 2014;85(4):50-55.
- Vishnevskiy V.A. Reasons and Diagnostic Errors in Cases of the Peripheral Nerves of Extremities Injuring. Zaporozhye Medical Journal. 2014;85(4):50-55. (In Russian).
- Боголюбский Ю.А., Файн А.М., Сачков А.В., Мажорова И.И., Ваза А.Ю., Титов Р.С. и др. Ятрогенные повреждения лучевого нерва при остеосинтезе плечевой кости. Профилактика, диагностика и лечение. Журнал имени Н.В. Склифосовского «Неотложная медицинская помощь». 2020;9(1):51-60. doi: 10.23934/2223-9022-2020-9-1-51-60.
- Bogolyubsky Y.A., Fayn A.M., Sachkov A.V., Mazhorova I.I., Vaza A.Y., Titov R.S. et al. Iatrogenic Damage to the Radial Nerve During Osteosynthesis of the Humerus. Prevention, Diagnosis and Treatment. Russian Sklifosovsky Journal «Emergency Medical Care». 2020;9(1):51-60. (In Russian). doi: 10.23934/2223-9022-2020-9-1-51-60.
- Боголюбский Ю.А., Файн А.М., Ваза А.Ю., Гнетецкий С.Ф., Мажорова И.И., Кишиневский Е.В. и др. Травматические и ятрогенные повреждения лучевого нерва при переломах диафиза плечевой кости. Практическая медицина. 2022;20(4):109-116.
- Bogolyubsky Y.A., Fain A.M., Vaza A.Y., Gnetetskiy S.F., Mazhorova I.I., Kishinevskiy E.V. et al. Traumatic and iatrogenic lesions of the radial nerve in fractures of humeris diaphysis. Practical Medicine. 2022;20(4):109-116.
- Temiz N.C., Doğan A., Kirik A., Yaşar S., Durmaz M.O., Kutlay A.M. Radial nerve injuries and outcomes: Our surgical experience. Ulus Travma Acil Cerrahi Derg. 2021;27(6):690-696. doi: 10.14744/tjtes.2020.34576.
- Kim D.H., Kam A.C., Chandika P., Tiel R.L., Kline D.G. Surgical management and outcome in patients with radial nerve lesions. J Neurosurg. 2001;95(4):573-583. doi: 10.3171/jns.2001.95.4.0573.
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