What is the real rate of radial nerve injury after humeral nonunion surgery?
Document Type
Article
Publication Date
8-1-2020
Publication Title
Journal of Orthopaedic Trauma
Abstract
Objectives:To determine the radial nerve palsy (RNP) rate and predictors of injury after humeral nonunion repair in a large multicenter sample.Design:Consecutive retrospective cohort review.Setting:Eighteen academic orthopedic trauma centers.Patients/Participants:Three hundred seventy-nine adult patients who underwent humeral shaft nonunion repair. Exclusion criteria were pathologic fracture and complete motor RNP before nonunion surgery.Intervention:Humeral shaft nonunion repair and assessment of postoperative radial nerve function.Main Outcome:Measurements: Demographics, nonunion characteristics, preoperative and postoperative radial nerve function and recovery.Results:Twenty-six (6.9%) of 379 patients (151 M, 228 F, ages 18-93 years) had worse radial nerve function after nonunion repair. This did not differ by surgical approach. Only location in the middle third of the humerus correlated with RNP (P = 0.02). A total of 15.8% of patients with iatrogenic nerve injury followed for a minimum of 12 months did not resolve. For those who recovered, resolution averaged 5.4 months. On average, partial/complete palsies resolved at 2.6 and 6.5 months, respectively. Sixty-one percent (20/33) of patients who presented with nerve injury before their nonunion surgery resolved.Conclusion:In a large series of patients treated operatively for humeral shaft nonunion, the RNP rate was 6.9%. Among patients with postoperative iatrogenic RNP, the rate of persistent RNP was 15.8%. This finding is more generalizable than previous reports. Midshaft fractures were associated with palsy, while surgical approach was not.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
First Page
441
Last Page
446
PubMed ID
32569074
Volume
34
Issue
8
Recommended Citation
Koh, Justin; Tornetta, Paul; Walker, Brock; Jones, Clifford; Sharmaa, Tayseer; Sems, Stephen; Ringenbach, Kathleen; Boateng, Henry; Bellevue, Kate; Firoozabadi, Reza; Spitler, Clay; Saxena, Sharul; Cannada, Lisa; Borade, Amrut; Horwitz, Daniel; Buck, J. Stewart; Bosse, Michael; Westberg, Jerald R.; Schmidt, Andrew; Kempton, Laurence; Newcomb, Emily; Marcantonio, Andrew; Delarosa, Matthew; Krause, Peter; Gudeman, Andrew; Mullis, Brian; Alhoukail, Amro; and Leighton, Ross, "What is the real rate of radial nerve injury after humeral nonunion surgery?" (2020). School of Medicine Faculty Publications. 1966.
https://digitalscholar.lsuhsc.edu/som_facpubs/1966