RESEARCH ARTICLE


Primary Exploration of Radial Nerve is Not Required for Radial Nerve Palsy while Treating Humerus Shaft Fractures with Unreamed Humerus Nails (UHN)



G Grass§, 1, K Kabir§, 2, J Ohse2, C Rangger2, L Besch3, G Mathiak*, 3
1 Geschäftsstelle der Ethik-Kommission der Medizinischen Fakultät der Universität zu Köln, Kerpener Str. 62, D-50937 Köln, Germany
2 Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Siegmund-Freud-Str. 25, D-53105 Bonn, Germany
3 Klinik für Unfallchirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 9, D-24105 Kiel, Germany


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Creative Commons License
© Grass et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Klinik für Unfallchirurgie UKSH, Campus Kiel/Chirurgie-Orthopädie Heikendorf, Teichtor 23, D-24226 Heikendorf/Kiel, Germany; Tel: 0431/243548; Fax: 0431/242696; E-mail: guenther.mathiak@web.de
§ Both authors contributed equally to the publication.


Abstract

Background:

Today, humerus nails have become the surgical method of choice in the treatment of humerus shaft fractures. Whether or not the radial nerve should be intraoperatively examined by default in case of primary paresis is currently under discussion.

Patients and Methods:

Clinical findings from 38 patients with humeral shaft fractures surgically treated with unreamed humerus nail (UHN) at the Department of Accident Surgery, University Clinics Bonn, Germany, between 2000 and 2003 were retrospectively assessed. Constant Score was applied for evaluation of functional results.

Results:

In 40% of patients, primary radial nerve paresis was present. This was especially common after high energy trauma (e.g. traffic accident) and significantly increased in fractures of the middle third. In 93% of cases, spontaneous remission of motor and sensory loss was observed. No iatrogenic radial nerve impairment occurred.

Conclusion:

Due to the high rates of spontaneous remissions of radial nerve palsy after treatment with UHN in humerus shaft fractures, primar exploration of the radial nerve does not appear to be necessary.

Keywords: Humerus shaft fracture, radial nerve, palsy, unreamed humerus nail (UHN), constant score.