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Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2012, Number 1

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Ortho-tips 2012; 8 (1)

Fundamentos de tratamiento en las fracturas de la diáfisis humeral con y sin lesiones del nervio radial

Masson MV

Language: Spanish
References: 18
Page: 26-36
PDF size: 60.99 Kb.


ABSTRACT

The humeral shaft fractures comprehend 3 to 5% of all the skeleton fractures, and are most commonly located on the diaphisys medial third and have a bimodal distribution which affects mainly young men and older women. The age range in the younger group is of 35, the masculine gender predominates (83%) and occurs after a high impact trauma including car accidents (51.6%), motorcycle accidents (9.9%), height free falls, direct impact wounds, firearm wounds, and those on which multiple trauma occurs. Within the largest group it happens primarily to women in their sixth decade of life, secondary to low impact wounds, generally as a result of a ground-level falls. The ulnar nerve wounds associated with the humeral diaphisys fractures occur approximately in 11% of the cases (ranging from 2-17%). In a series of 5,777 patients with multiple wounds in a trauma concentration center, the humeral diaphisys fractures were associated to radial nerve wounds in 9.5% of the cases, ulnar nerve in 3.8% and medium nerve in 1.4%. Most of the humeral diaphisis fractures are treated and closed without surgical need with excellent results documented in many studies. The surgical treatment of humeral diaphisis fractures enclose absolute and relative indications. Within the absolute indications are the arterial injuries, open fractures, and float elbow. The relative indications for the surgical treatment of the humeral diaphisys fractures have to consider the natural history of the non-surgical and surgical treatment in the terms of the final forecast and associated morbility with both treatments. This article intends to form a rational handling in the treatment of the humeral diaphisys fractures with and without radial nerv injuries considering the actual knowledge of the basic sciences, the personality of the fracture, and the patient and surgeon factors.


REFERENCES

  1. Agnew SP, Dumanian GA. Technical use of synthetic conduits for nerve repair. J Hand Surg Am 2010; 35(5): 838-841.

  2. Amillo S, Barrios RH, Martinez-Peric R, Losada JI. Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma 1993; 7(3): 211-215.

  3. Bell MJ, Beauchamp CG, Kellam JK, McMurtry RY. The results of plating humeral shaft fractures in patients with multiple injuries. JBJS; 1985; 67B: 293-296.

  4. Burnett MG, Zager EL. Pathophysiology of peripheral nerve injudy: a brief review. Neurosurg Focus 2004; 16 (5): E1.

  5. De Franco MJ, Lawton JN. Radial nerve injuries associated with humeral fractures. Journal Hand Surgery; 2006; 31A: 655-663.

  6. Dormans JP, Squillante R, Sharf H. Acute neurovascular complications with supracondylar humerus fractures in children. J Hand Surg 1995; 20: 1-4.

  7. Ekholm R, Ponzer S, Tornkvist H, Adami J, Tidermark J. The Holstein-Lewis humeral shaft fracture: aspects of radial nerve injury, primary treatment and outcome. J Orthop Trauma 2008; 22(10): 693-697.

  8. Foster RJ, Swiontkowski MF, Bach AW, Sack JT. Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg (Am) 1993; 18: 121-124.

  9. García A Jr, Maeck BH. Radial nerve injuries in fractures of the shaft of the humerus. Am J Surg 1960; 99: 625-627.

  10. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five fractures of the long bones: retrospective and prospective analysis. JBJS 1976; 58A: 453-458.

  11. Hak DJ. Radial nerve palsy associated with humeral shaft fractures. Orthopedics 2009; 32(2): 111.

  12. Hoppenfeld S, deBoer P, eds. Surgical exposures in orthopaedics: The anatomic approach, 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003.

  13. Holstein A, Lewis GB. Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg Am 1963; 45: 1382-1388.

  14. Jawa A, McCart y P, Doomberg J, Harris M, Ring D. Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am 2006: 88: 2343-2347.

  15. Kang Jr. BS, Zamorano DP, Gupta R. Limb salvage with major nerve injury: Current management and future directions. J Am Acad Orthop Surg 2011; 19: S28-S34.

  16. Kettlekamp DB, Alexander H. Clinical review of radial nerve injury. J Trauma 1967; 7: 424-432.

  17. Mohler LR, Hanel DP. Closed fractures complicated by peripheral nerve injury. J Am Acad Orthop Surg 14(1): 32-37.

  18. Parkes AR. A report of traumatic ischemia of peripheral nerves with some observations on Volkmann’s ischemic contracture. Br J Surg 1945; 32: 403.




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