scholarly journals The risk of iatrogenic radial nerve and/or profunda brachii artery injury in anterolateral humeral plating using a 4.5 mm narrow DCP: A cadaveric study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260448
Author(s):  
Chaiwat Chuaychoosakoon ◽  
Supatat Chirattikalwong ◽  
Watit Wuttimanop ◽  
Tanarat Boonriong ◽  
Wachiraphan Parinyakhup ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Dynamic Compression ◽  
Fracture Line ◽  
Humeral Shaft ◽  
Anterolateral Approach ◽  
Lateral Epicondyle ◽  
Screw Hole ◽  
Artery Injury ◽  
Fresh Frozen ◽  
Proximal Screw

Introduction Fixation of humeral shaft fractures with a plate and screws can endanger the neurovascular structure if proper care is not taken. No studies to our knowledge have studied the risk of iatrogenic radial nerve and/or profunda brachii artery (RNPBA) injury from each screw hole of a 4.5 mm narrow dynamic compression plate (narrow DCP). The purpose of this study is to evaluate the risk of RNPBA injury in anterolateral humeral plating with a 4.5 mm narrow DCP. Material and methods 18 humeri of 9 fresh-frozen cadavers in the supine position were exposed via the anterolateral approach with 45 degrees of arm abduction. A hypothetical fracture line was marked at the midpoint of each humerus. A precontoured ten-hole 4.5mm narrow DCP was applied to the anterolateral surface of the humerus using the fracture line to position the center of the plate. All screw holes were drilled and screws inserted. The cadaver was then turned over to the prone position with 45 degrees of arm abduction, and the RNPBA exposed. The holes through in which 100% of the screw had contact with or penetrated the RNPBA were identified as dangerous screw holes, while lesser percentages of contact were defined as risky. Results The relative distance ratios of the entire humeral length from the lateral epicondyle of the humerus to the 4th, 3rd, 2nd and 1st proximal holes were 0.64, 0.60, 0.56 and 0.52, respectively. The most dangerous screw hole was the 2nd proximal, in which all 18 screws had contacted or penetrated the nerve, followed by the risky 1st (12/18), 3rd (8/18) and 4th (2/18) holes. Conclusion In humeral shaft plating with the 4.5mm narrow DCP using the anterolateral approach, the 2nd proximal screw hole carries the highest risk of iatrogenic radial nerve and/or profunda brachii artery injury.

scholarly journals Anterolateral approach with two incisions versus posterior median approach in the treatment of middle- and distal-third humeral shaft fractures

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Qiang Huang ◽  
Yao Lu ◽  
Zhi Meng Wang ◽  
Liang Sun ◽  
Teng Ma ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Humeral Shaft ◽  
Surgical Approaches ◽  
Anterolateral Approach ◽  
Clinical Effects ◽  
Incision Length ◽  
Posterior Median ◽  
Humeral Shaft Fractures ◽  
Radial Nerve Injury ◽  
Median Approach

Abstract Background The surgical approaches remain controversial for the treatment of middle and distal-third humeral shaft (MDTHS) fractures. This study compared clinical effects of the anterolateral approach with two incisions (AATI) and the posterior median approach (PMA) in the treatment of MDTHS fractures. Methods A retrospective analysis was carried out. One hundred sixty-six patients with MDTHS fractures were selected from January 2015 to January 2017 in Xi’an Hong Hui Hospital. According to surgical approaches, patients were divided into AATI (86 cases) and PMA group (80 cases). All patients were treated with open reduction and plate fixation. Operation indexes were compared, including incision length, operation time, and bleeding. Bryan-Morrey score was used to evaluate elbow joint function. Complication incidence was compared, such as incision infection, iatrogenic radial nerve injury, and nonunion. Results The AATI group showed smaller incision length, less bleeding, lower iatrogenic radial nerve injury rate, and better elbow function than that of PMA group (P<0.05). Conclusions The middle and distal-third humeral shaft fractures can be successfully cured by both approaches. Compared with the posterior median approach, it has better clinical effects of the anterolateral approach with two incisions, which is worthy of clinical application and promotion.

scholarly journals Functional outcome of middle third humeral shaft fractures treated with anteromedial plate osteosynthesis through an anterolateral approach

2018 ◽  
Vol 4 (3) ◽  
pp. 436
Author(s):  
Sandeep Kubsad ◽  
Suresh B. ◽  
Bharath S. G. ◽  
Manohar Reddy ◽  
Harish S. Pai
Keyword(s):  
Functional Outcome ◽  
Nerve Injury ◽  
Functional Assessment ◽  
Radial Nerve ◽  
Plate Osteosynthesis ◽  
Humeral Fractures ◽  
Humeral Shaft ◽  
Anterolateral Approach ◽  
Humeral Shaft Fractures ◽  
Radial Nerve Injury

<p class="abstract"><strong>Background:</strong> The main aim of treatment of the humeral shaft fractures is to establish union with an acceptable humeral alignment and to restore the patient to pre-injury level of function. Plate osteosynthesis remains the standard of surgical treatment displaced middle third humeral fractures. The most commonly used approaches for treating these fractures are posterior and anterolateral, but these approaches can have iatrogenic radial nerve injury. Our aim is to study the incidence of radial nerve palsy and functional outcome of anterolateral approach with anteromedial plating.</p><p class="abstract"><strong>Methods:</strong> A total of 26 patients in the age group of 21 to 62 years were included in this prospective study, who were treated by anteromedial plating through anterolateral approach for humerus shaft. Functional assessment was done using Rodriguez-Merchan criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> 26 patients with shaft humerus fracture were included in the study with 19 (73%) patients were less than 40 years age. Most common type of fracture pattern is A3 type and the mean duration of surgical time was 60±10 min for anteromedial plating. The time taken for the fracture union was less than 4 months in the most patients (88%). There was no evidence of iatrogenic radial nerve injury. Functional assessment done using Rodriguez-Merchan criteria showed 84.6% of the patients had good to excellent functional outcome.</p><p class="abstract"><strong>Conclusions:</strong> For treatment of displaced middle third humeral fractures open reduction with anteromedial plating through anterolateral approach is surgically safer and gives better functional outcome.</p><p class="abstract"> </p>

scholarly journals Anatomic Relationship Between the Radial Nerve and the Musculo-Fascial Structures of the Arm and Forearm: A Cadaveric and Sonographic Study

2020 ◽  
Author(s):  
José García Martínez ◽  
Gerard Alvarez ◽  
Albert Perez-Bellmunt ◽  
Maribel Miguel ◽  
Ginés Viscor
Keyword(s):  
Radial Nerve ◽  
Motor Branch ◽  
Lateral Epicondyle ◽  
Anatomical Dissection ◽  
Arm Pain ◽  
Ultrasound Study ◽  
Adjacent Structures ◽  
Fresh Frozen ◽  
Relationship Of ◽  
The Relationship

Abstract Background: Radial nerve (RN) compression most commonly occurs at the level of the supinator arch (SA), also called arcade of Fröhse, but other sites of entrapment along the course of the nerve are possible. This study aimed to perform an ultrasound and anatomical examination of these entrapment sites, to provide a solid anatomical base for the differential diagnosis of lateral arm pain, to allow a more precise manual therapy approach. Methods: Nineteen fresh-frozen cadavers were examined, first on ultrasound then on anatomical dissection. Two points of possible RN entrapment were injected with dye under ultrasound guidance: where the RN crosses the lateral intermuscular septum (LIMS) and at the SA. Dissection confirmed the location of the dye at these points and allowed us to describe the relationship of the RN with the adjacent structures; the distances from each of these two points to the lateral epicondyle and the diameter of the RN were also measured. Results: The dye was observed in the correct place in all specimens. We observed a close relationship of the RN with the lateral head of triceps brachialis (LHTB) muscle and the LIMS as it passed through these structures. In both structures, longitudinal aponeurotic extensions were observed. In the anterior compartment of the arm, where the RN glides between the brachialis (B) and brachioradialis (BR) muscles, we observed varying relationships between these three structures (5% had vascular unions, 79% had union of the epimysium, and 16% muscular unions). Finally, in the forearm, just before reaching the SA, we observed a septum that compartmentalize the forearm musculature and created an aponeurotic arch through which the motor branch of the RN passed. Conclusions: Ultrasound study helps correctly identify the RN; the two points identified on US and dissection correlated well. The anatomical findings on the relationship of the RN with its surrounding structures may explain its entrapment.

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

2021 ◽  
Author(s):  
Rebekah Belayneh ◽  
Connor P. Littlefield ◽  
Sanjit R. Konda ◽  
Kari Broder ◽  
David N. Kugelman ◽  
...  
Keyword(s):  
Radial Nerve ◽  
Humeral Shaft

ANATOMICAL STUDY OF ARCADE OF STRUTHERS

Hand Surgery ◽  
2010 ◽  
Vol 15 (03) ◽  
pp. 157-159 ◽  
Author(s):  
Piyapong Tiyaworanan ◽  
Surut Jianmongkol ◽  
Tala Thammaroj
Keyword(s):  
Ulnar Nerve ◽  
Anatomical Study ◽  
Medial Epicondyle ◽  
Anatomical Location ◽  
Greater Tuberosity ◽  
Lateral Epicondyle ◽  
Surgical Exploration ◽  
Fresh Frozen ◽  
The Mean ◽  
Proximal Border

The incidence and the anatomical location of the arcade of Struthers as related to the arm length were studied in 62 arms of adult fresh-frozen cadavers. The distance between the greater tuberosity and the lateral epicondyle was designated as the arm length. The arcades of Struthers were identified in 85.4%. The mean arm length was 27.85 ± 1.3 cm. The mean of the distance between proximal border of the arcade of Struthers and the medial humeral epicondyle was 8.24 ± 2.06 cm. The mean ratio between the distance from the proximal border of the arcade to the tip of the medial epicondyle and arm length was 0.29 ± 0.07. We concluded that the anatomical location of the arcade as related to the arm length was 29% proximally, from the tip of the medial epicondyle. This report of the anatomical location of the arcade of Struthers related to the arm length can be useful to identify this structure in the arms which have differences in arm length during the surgical exploration and anterior transposition of the ulnar nerve procedures.

Treatment of Brachial Artery Injury with Humeral Shaft Fracture Using Endovascular Stenting

2010 ◽  
Vol 45 (6) ◽  
pp. 490
Author(s):  
Suk Kang ◽  
Phil-Hyun Chung ◽  
Chung-Soo Whang ◽  
Jong-Pil Kim ◽  
Young-Sung Kim ◽  
...  
Keyword(s):  
Brachial Artery ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Endovascular Stenting ◽  
Artery Injury

scholarly journals Location of the radial nerve along the humeral shaft between the prone and lateral decubitus positions at different elbow positions

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sitthiphong Suwannaphisit ◽  
Wachirakorn Aonsong ◽  
Porames Suwanno ◽  
Chaiwat Chuaychoosakoon
Keyword(s):  
Radial Nerve ◽  
Minimum Distance ◽  
Posterior Approach ◽  
Elbow Flexion ◽  
Lateral Decubitus Position ◽  
Full Extension ◽  
Posterior Aspect ◽  
Lateral Epicondyle ◽  
Lateral Decubitus ◽  
The Mean

AbstractIdentification of the radial nerve is important during the posterior approach to a humerus fracture. During this procedure, the patient can be placed in the prone or lateral decubitus position depending on the surgeon’s preference. The distance from the radial nerve to the osseous structures will be different in each position. The purpose of this study was to identify the safety zones in various patient and elbow flexion positions. The distances from the olecranon to the center of the radial groove and intermuscular septum and lateral epicondyle to the lateral intermuscular septum were measured using a digital Vernier caliper. The measurements were performed with cadavers in the lateral decubitus and prone positions at different elbow flexion angles. The distance from where the radial nerve crossed the posterior aspect of the humerus measured from the upper part of the olecranon to the center of the radial nerve in both positions at different elbow flexion angles varied from a mean maximum distance of 130.00 mm with the elbow in full extension in the prone position to a minimum distance of 121.01 mm with the elbow in flexion at 120° in the lateral decubitus position. The mean distance of the radial nerve from the upper olecranon to the lateral intermuscular septum varied from 107.13 to 102.22 mm. The distance from the lateral epicondyle to the lateral edge of the radial nerve varied from 119.92 to 125.38 mm. There was not significant contrast in the position of the radial nerve with osseous landmarks concerning different degrees of flexion, except for 120°, which is not significant, as this flexion angle is rarely used.

scholarly journals Humeral shaft fracture associated with radial nerve palsy -a case report

2021 ◽  
pp. 54-55
Author(s):  
Rishitha M ◽  
Akasha Sindhu M
Keyword(s):  
Radial Nerve ◽  
Nerve Palsy ◽  
Wrist Joint ◽  
Shaft Fracture ◽  
Humeral Shaft Fracture ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Loss Of Function ◽  
History Of ◽  
The Right

Radial nerve palsy was induced by radial nerve compression, which was often caused by humerus bone fracture. This leads to pain, weakness, or loss of function mostly in the wrist, hand, and fingers. We reported a case of a 24-year-old male patient with complaints of swelling of the right-hand wrist joint and pain during extension and flexion while moving. He had a three-month history of mild displaced humeral shaft fracture from a traffic accident and an intramedullary Ender nailing was performed. He now has been admitted with swelling in his right wrist joint and pain while moving his hand. The case was diagnosed as Radial nerve palsy. Surgery was performed, the proximal and distal ends of the radial nerve were separated at the humeral bone's surface. The radial nerve stumps were enough long to be sutured. Our one-month follow-up shows no complications. The majority cases of radial nerve palsy will resolve within a few weeks after surgery, as our patient did, and the most prominent is patient education.

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