Shear Wave Elastography to Guide Perineural Hydrodissection: Two Case Reports

Radial nerve palsy is not uncommon after humeral shaft fractures. Ultrasound-guided hydrodissection is an emerging treatment for nerve entrapment. Two cases of radial nerve injury after humeral shaft fractures with plate fixation are presented. Shear wave elastography was used to identify hardened scars surrounding the nerve, causing entrapment. These areas were marked on the skin as targets for ultrasound-guided hydrodissection. Each patient experienced full recovery of their radial nerve function. Shear wave elastography may be used to precisely identify sites of neural entrapment by scar tissue and accurately guide perineural hydrodissection, particularly in complex postoperative cases.

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Ultrasound-guided Preoperative Localization of Radial Nerve in the Treatment of Extra-articular Distal Humeral Shaft Fractures

10.21203/rs.3.rs-875837/v1 ◽

2021 ◽

Author(s):

Weifeng Li ◽

Qian Wang ◽

Haiying Wang ◽

shunyi wang

Keyword(s):

Radial Nerve ◽

Operative Time ◽

Humeral Shaft ◽

Preoperative Localization ◽

Radial Nerve Palsy ◽

Ultrasound Guided ◽

Intraoperative Bleeding ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Bleeding Volume

Abstract Background: The aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve.Methods: Between May 2014 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. 28 patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS). Results: A significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (p < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (p < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (p < 0.001) and iatrogenic radial nerve palsy rate (0 vs 10.7% ) (p< 0.001). However, the fracture union time (13.52 months vs 12.96 months) (p = 0.796) and the MEPS sscore (87.56 vs 86.38) (p = 0.594) were no significantly different in both groups. Conclusion: The study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the incidence of iatrogenic radial nerve injury and the intraoperative bleeding volume. In addition, it has the advantages of operability, safety, efficiency and repeatability.

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