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David Ring - One of the best experts on this subject based on the ideXlab platform.
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factors associated with Radial Nerve palsy after operative treatment of diaphyseal humeral shaft fractures
Journal of Shoulder and Elbow Surgery, 2015Co-Authors: Femke M A P Claessen, Rinne M Peters, Diederik O Verbeek, David L Helfet, David RingAbstract:Background The Radial Nerve is at risk after diaphyseal humeral fracture or surgery to repair the fracture. We hypothesized that there are no factors associated with iatrogenic Radial Nerve palsy and, secondarily, that there are no factors associated with traumatic Radial Nerve palsy or Radial Nerve palsy of any type. Methods We analyzed 325 adult patients who underwent operative treatment of a diaphyseal humerus fracture at 6 hospitals between January 2002 and November 2014 to determine factors associated with a Radial Nerve palsy. We excluded patients with pathologic fractures, fractures with massive bone loss, prior surgery in another hospital, periprosthetic fractures, and if no operative note was available. Results In patients without a traumatic Radial Nerve palsy, an iatrogenic Radial Nerve palsy occurred in 18 of 259 diaphyseal humeral fractures (7%). The surgical approach was associated with iatrogenic Radial Nerve palsy ( P = .034). No factors were associated with traumatic Radial Nerve palsy (66 of 325 patients [20%]) of the humeral diaphysis. Open fractures, location of fracture, and high-energy trauma were significantly associated with Radial Nerve palsy of any type (84 of 325 patients [26%]). Conclusions Patients and surgeons should keep in mind that iatrogenic transient dysfunction of the Radial Nerve will occur in approximately 1 in 5 patients treated with lateral exposure of the humerus, in 1 in 9 patients treated with posterior exposure, and in 1 in 25 patients with an anterolateral exposure.
Thomas H Tung - One of the best experts on this subject based on the ideXlab platform.
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median to Radial Nerve transfer for treatment of Radial Nerve palsy case report
Journal of Neurosurgery, 2007Co-Authors: Susan E. Mackinnon, Brandon Roque, Thomas H TungAbstract:✓The purpose of this study is to report a surgical technique of Nerve transfer to restore Radial Nerve function after a complete palsy due to a proximal injury to the Radial Nerve. The authors report the case of a patient who underwent direct Nerve transfer of redundant or expendable motor branches of the median Nerve in the proximal forearm to the extensor carpi Radialis brevis and the posterior interosseous branches of the Radial Nerve. Assessment included degree of recovery of wrist and finger extension, and median Nerve function including pinch and grip strength. Clinical evidence of reinnervation was noted at 6 months postoperatively. The follow-up period was 18 months. Recovery of finger and wrist extension was almost complete with Grade 4/5 strength. Pinch and grip strength were improved postoperatively. No motor or sensory deficits related to the median Nerve were noted, and the patient is very satisfied with her degree of functional restoration. Transfer of redundant synergistic motor branches of...
Susan E. Mackinnon - One of the best experts on this subject based on the ideXlab platform.
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Median to Radial Nerve transfer after traumatic Radial Nerve avulsion in a pediatric patient.
Journal of Neurosurgery, 2019Co-Authors: Ellen L. Larson, Katherine B. Santosa, Susan E. Mackinnon, Alison K. Snyder-warwickAbstract:This case report describes an isolated Radial Nerve avulsion in a pediatric patient, treated by combination sensory and motor median to Radial Nerve transfers. After traumatic avulsion of the proximal Radial Nerve, a 12-year-old male patient underwent end-to-end transfer of median Nerve branches to flexor carpi Radialis and flexor digitorum superficialis to the posterior interosseous Nerve and extensor carpi Radialis Nerve, respectively. He underwent end-to-side sensory transfer of the superficial Radial sensory to the median sensory Nerve. Pronator teres to extensor carpi Radialis brevis tendon transfer was simultaneously performed to power short-term wrist extension. Within months after surgery, the patient had regained 9-10/10 sensation in the hand and forearm. In the following months and years, he regained dexterity, independent fine-finger and thumb motions, and 4-5/5 strength in all extensors except the abductor pollicis longus muscle. He grew 25 cm without extremity deformity or need for secondary orthopedic procedures. In appropriate adult and pediatric patients with proximal Radial Nerve injuries, Nerve transfers have advantages over tendon transfers, including restored independent fine finger motions, regained sensation, and reinnervation of multiple muscle groups with minimal donor sacrifice.
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median to Radial Nerve transfer for treatment of Radial Nerve palsy case report
Journal of Neurosurgery, 2007Co-Authors: Susan E. Mackinnon, Brandon Roque, Thomas H TungAbstract:✓The purpose of this study is to report a surgical technique of Nerve transfer to restore Radial Nerve function after a complete palsy due to a proximal injury to the Radial Nerve. The authors report the case of a patient who underwent direct Nerve transfer of redundant or expendable motor branches of the median Nerve in the proximal forearm to the extensor carpi Radialis brevis and the posterior interosseous branches of the Radial Nerve. Assessment included degree of recovery of wrist and finger extension, and median Nerve function including pinch and grip strength. Clinical evidence of reinnervation was noted at 6 months postoperatively. The follow-up period was 18 months. Recovery of finger and wrist extension was almost complete with Grade 4/5 strength. Pinch and grip strength were improved postoperatively. No motor or sensory deficits related to the median Nerve were noted, and the patient is very satisfied with her degree of functional restoration. Transfer of redundant synergistic motor branches of...
Peter J L Jebson - One of the best experts on this subject based on the ideXlab platform.
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current treatment of Radial Nerve palsy following fracture of the humeral shaft
Journal of Hand Surgery (European Volume), 2008Co-Authors: Apurva S Shah, Peter J L JebsonAbstract:a I c i w n a In B ri ef HE ASSOCIATION BETWEEN Radial Nerve injury and humeral shaft fracture was described by Berkeley surgeons Holstein and Lewis, who oberved Radial Nerve palsy in the setting of spiral fracures of the distal third of the humeral shaft wherein the distal bone fragment is always displaced proxially with its proximal end deviated Radialward” and hat “the Radial Nerve is caught in the fracture site.” ubsequent reports have described cases of Radial Nerve alsy following fractures of the middle third of the shaft f the humerus as well. A recently published anaomical study by Carlan et al. emphasizes that the Radial erve is at risk of injury in these 2 regions: (1) along the osterior mid-aspect of the humerus where the Nerve ies in direct contact with the periosteum and (2) along he distal lateral humerus where the Nerve pierces the ateral intermuscular septum. A recent epidemiological study documented a 9% ncidence of Radial Nerve injury following humeral shaft racture, whereas a systematic review of the literature oted a 12% incidence. Radial Nerve palsy may be ither partial or complete; complete motor loss occurs n approximately 50% of cases. Radial Nerve palsy in he setting of humeral shaft fracture can be further lassified as primary or secondary. In primary Nerve alsy, loss of function occurs at the time of injury. In econdary Nerve palsy, loss of function occurs during he course of treatment. Because prospective randomzed clinical trials have not evaluated treatment of this njury, our clinical decision making has to be based on he empiric evidence garnered from retrospective case eries. In complete primary Radial Nerve palsy associated
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current treatment of Radial Nerve palsy following fracture of the humeral shaft
Journal of Hand Surgery (European Volume), 2008Co-Authors: Apurva S Shah, Peter J L JebsonAbstract:a I c i w n a In B ri ef HE ASSOCIATION BETWEEN Radial Nerve injury and humeral shaft fracture was described by Berkeley surgeons Holstein and Lewis, who oberved Radial Nerve palsy in the setting of spiral fracures of the distal third of the humeral shaft wherein the distal bone fragment is always displaced proxially with its proximal end deviated Radialward” and hat “the Radial Nerve is caught in the fracture site.” ubsequent reports have described cases of Radial Nerve alsy following fractures of the middle third of the shaft f the humerus as well. A recently published anaomical study by Carlan et al. emphasizes that the Radial erve is at risk of injury in these 2 regions: (1) along the osterior mid-aspect of the humerus where the Nerve ies in direct contact with the periosteum and (2) along he distal lateral humerus where the Nerve pierces the ateral intermuscular septum. A recent epidemiological study documented a 9% ncidence of Radial Nerve injury following humeral shaft racture, whereas a systematic review of the literature oted a 12% incidence. Radial Nerve palsy may be ither partial or complete; complete motor loss occurs n approximately 50% of cases. Radial Nerve palsy in he setting of humeral shaft fracture can be further lassified as primary or secondary. In primary Nerve alsy, loss of function occurs at the time of injury. In econdary Nerve palsy, loss of function occurs during he course of treatment. Because prospective randomzed clinical trials have not evaluated treatment of this njury, our clinical decision making has to be based on he empiric evidence garnered from retrospective case eries. In complete primary Radial Nerve palsy associated
Femke M A P Claessen - One of the best experts on this subject based on the ideXlab platform.
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factors associated with Radial Nerve palsy after operative treatment of diaphyseal humeral shaft fractures
Journal of Shoulder and Elbow Surgery, 2015Co-Authors: Femke M A P Claessen, Rinne M Peters, Diederik O Verbeek, David L Helfet, David RingAbstract:Background The Radial Nerve is at risk after diaphyseal humeral fracture or surgery to repair the fracture. We hypothesized that there are no factors associated with iatrogenic Radial Nerve palsy and, secondarily, that there are no factors associated with traumatic Radial Nerve palsy or Radial Nerve palsy of any type. Methods We analyzed 325 adult patients who underwent operative treatment of a diaphyseal humerus fracture at 6 hospitals between January 2002 and November 2014 to determine factors associated with a Radial Nerve palsy. We excluded patients with pathologic fractures, fractures with massive bone loss, prior surgery in another hospital, periprosthetic fractures, and if no operative note was available. Results In patients without a traumatic Radial Nerve palsy, an iatrogenic Radial Nerve palsy occurred in 18 of 259 diaphyseal humeral fractures (7%). The surgical approach was associated with iatrogenic Radial Nerve palsy ( P = .034). No factors were associated with traumatic Radial Nerve palsy (66 of 325 patients [20%]) of the humeral diaphysis. Open fractures, location of fracture, and high-energy trauma were significantly associated with Radial Nerve palsy of any type (84 of 325 patients [26%]). Conclusions Patients and surgeons should keep in mind that iatrogenic transient dysfunction of the Radial Nerve will occur in approximately 1 in 5 patients treated with lateral exposure of the humerus, in 1 in 9 patients treated with posterior exposure, and in 1 in 25 patients with an anterolateral exposure.
