Prevention of the Radial Nerve Injury During Operation of the Humerus Shaft Fracture

Journal of the Korean Society for Surgery of the Hand 2004;9(1):32-35.
Published online January 1, 2004.

Min Jong Park, Byung Dam Ryu

상완골 간부 골절 수술 중 발생하는 요골 신경 손상의 예방

박민종, 류병담

Abstract

Purpose
The risk of iatrogenic radial nerve injury should be considered during operation of the humerus shaft fractures. We investigated factors related to the radial nerve injury in patients who underwent operation for humerus shaft fractures. Materials and Methods: We analyzed 103 humerus shaft fractures in 99 patients. Patients who had had the radial nerve injury before operation were excluded. The radial nerve injury was observed in 7 cases after the operation. To find causative factors of intraoperative radial nerve injury, we analyzed the patients based on the diagnosis, the location of fracture, surgical approach, operation time, tourniquet application, and intra-operative dissection of the radial nerve. Result: In 7 intraoperative radial nerve injuries, there were 4 acute humeral shaft fractures and 3 humerus shaft nonunions. Higher rate of radial nerve palsy was observed in operation of nonunions compared to that of acute fractures. Radial nerve injury occurred in 2 middle shaft fractures, one middle to distal fracture, and 4 distal fractures. Injury rate was significantly higher in the distal fractures. Conclusion: In operation of the humerus shaft nonunions, the radial nerve is vulnerable to injury due to its adhesion with surrounding tissues, requiring careful dissection during operation. To reduce the risk of radial nerve injury in distal shaft fractures, we recommend the posterolateral approach and maintenance of flexed elbow position during operation.