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Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología

2008, Number 5

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Acta Ortop Mex 2008; 22 (5)

A comparison of the prevalence of radial nerve lesion after fixationof humeral shaft fractures with dynamic compression plate Versus intramedullary nailing

Huerta LJ, Luna PD

Language: Spanish
References: 16
Page: 287-291
PDF size: 156.80 Kb.


ABSTRACT

Material and methods: We conducted this study in the thoracic extremity surgery module, from the Trauma and Orthopedic Surgery Hospital «Lomas Verdes» of the Instituto Mexicano del Seguro Social (IMSS) from September 2001 to 2004. Eighty-seven patients were included with ages between 16 to 81 years, with the diagnosis of humeral shaft fracture without previous neurologic lesion and were treated with intramedullary nail or dynamic compression plate (DCP) with a 2 year follow up. Results: Eighty seven patients were evaluated; mean age 42.2 ± 3.2 years; male gender (61%) vs female gender (39%) (p ‹ 0.05); more frequently affected extremity: left (59.7) vs right (40.3%); acute period fracture: 59.7%; non union 25.3% and delay of consolidation: 15%. Implant used: DCP plate (80%) vs intramedullary nailing (20%) (p ‹ 0.05%). Radial nerve lesion at the beginning and end of the study: 15 (22%) of 70 patients vs 1 (5.5%) of 17 patients operated with DCP plate vs intramedullary nail respectively. Of the 16 radial nerve lesions on total (100%), 12 presented with neuroapraxia (10.4%) that included a patient treated with intramedullary nailing and 4 (3.4%) axonotmesis treated with open reduction and internal fixation with DCP. Conclusion: The preference of treatment on our hospital is the use of DCP in humeral shaft fractures. The surgical technique with DCP represents a higher incidence of radial nerve lesion probably due to the exposure and proximity to the radial nerve during surgery. It will be necessary to verify these results in a clinical controlled trial.


REFERENCES

  1. DeFranco MJ, Lawton JN: Radial nerve injuries associated with humeral fractures. J Hand Surg Am 2006; 31: 655-63.

  2. Foster RJ, Swiontkowski MF, Bach AW, Sack JT: Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg (Am) 1993; 18(1): 121-4.

  3. Hunter SG: The closed treatment of fractures of the humeral shaft. Clint Orthop 1982; 164: 192-2.

  4. Kumar A, Sadiq SA: Non-union of the humeral shaft treated by internal fixation. Int Orthop 2000; 26: 214-6.

  5. Yang KH, DY, Kim HJ: Intramedullary entrapment of the radial nerve associated with humeral shaft fracture. J Orthop Trauma 1997; 11(3): 224-6.

  6. Ring D, Perey BH Jupiter JB: The functional outcome of operative treatment of ununited fractures of the humeral diaphysis in older patients. J Bone Joint Surg Am 1999; 81(2): 177-90.

  7. Sarmiento A, et al. Functional bracing of fractures of the shaft of the humerus. J Bone Joint Surg 1977; 59A: 596-601.

  8. Muller T, Seligson D, Sioen W, Van den Bergh J, Reynaert P: Operative treatment of humeral shaft fractures. Act Orthop Belg 1997; 63(39): 170-7.

  9. Botempo E, Trager SL: Ball trower´s Fracture of the humerus associated with radial nerve palsy. Orthopedics 1996; 19(6): 537-40.

  10. Zinman C, Norman D, et al. External for severe open fixation fractures of the humerus caused by missils. J Orthopaedic Trauma 1997, Oct; 11(7):536-9.

  11. Bodner G, Buchberger W, Schocke M, Bale R, Huber, Harpf C, Gassner E, Jashke W: Radial nerve palsy associated with humeral shaft fracture: Evaluation with US-initial experience. Radiology 2001; 219(3): 811-6.

  12. Foster RJ, Dixon GL Jr, Bach AW, Appleyard, RW, Green TM: Internal fixation of fractures non-unions of the humeral shaft. Indications and results in a multi-center study. J Bone Joint Surg Am 1985; 67(6): 857-64.

  13. Chesser TJ, Leslie IJ: Radial Nerve entrapment by the lateral intermuscular septum after trauma. J Orthop Trauma 2000; 14(1): 65-6.

  14. McCormack RG, Brien D, Buckley RE, Mckee MD, Powell J, Schemitsch EH: Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail: a prospective, randomized trial. J Bone Joint Surg Br 2000; 82: 336-9.

  15. Muller ME, Allgöwer M, Schneider R, Willenegger H: Manual de osteosíntesis. Tercera edición 1993.

  16. Martinez AA, Cuenca J, Herrera A: Treatment of humeral shaft nonunions:mailing versus plating. Arch Orthop Trauma Surg 2004; 24: 2-95.




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