BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation o...BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness.We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1,2016,and March 31,2020.Subsequently,we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTS The study included 70 patients who underwent surgical treatment for closed-or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration.The patients suffered from primary(n=5)and secondary(n=5)radial nerve palsy.A 100%radial nerve recovery rate was achieved.The mean recovery time was 4.3 mo.CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment.Surgeons need not be concerned about the occurrence of permanent nerve palsies.展开更多
In this article, we present a case of humeral biepicondylar fracture dislocation concomitant with ulnar nerve injury in a seventeen year-old male patient. Physical examination of our patient in the emergency room reve...In this article, we present a case of humeral biepicondylar fracture dislocation concomitant with ulnar nerve injury in a seventeen year-old male patient. Physical examination of our patient in the emergency room revealed a painful, edematous and deformed-looking left elbow joint. Hypoesthesia of the little finger was also diagnosed on the left hand. Radiological assessment ended up with a posterior fracture dislocation of the elbow joint accompanied by intra-articular loose bodies. Open reduction-Internal fixation of the fracture dislocation and ulnar nerve exploration were performed under general anesthesia at the same session as surgical treatment of our patient. Physical therapy and rehabilitation protocol was implemented at the end of two weeks post-operatively. Union of the fracture lines, as well as the olecranon osteotomy site, was achieved at the end of four months post-operatively. Ulnar nerve function was fully restored without any sensory or motor loss. Range of motion at the elbow joint was 20-120 degrees at the latest follow-up.展开更多
Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar...Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.展开更多
Radial nerve palsy is the most common neurological involvement in humeral shaft fractures.But combined radial and median nerve injury in a closed diaphyseal fracture of the humerus is rare.Combined injury to both radi...Radial nerve palsy is the most common neurological involvement in humeral shaft fractures.But combined radial and median nerve injury in a closed diaphyseal fracture of the humerus is rare.Combined injury to both radial and median nerve can cause significant disability.A detailed clinical examination is therefore necessary following humeral shaft fractures.We report a patient with closed diaphyseal humeral fracture （AO 12A-2.3） together with radial and median nerve palsy,its management and review of the literature.As the patient had two nerves involved,surgical exploration was planned.Fracture was reduced and fixed with a 4.5 mm narrow dynamic compression pla te.There was no external injury to both radial and median nerves on surgical exploration.Neurological recovery started at 3 weeks＇ follow-up.Complete recovery was seen at 12 weeks.Careful clinical examination is of the utmost importance in early diagnosis of combined nerve injuries,which allows better management and rehabilitation of the patient.展开更多
目的:肱骨髁上骨折是儿童肘部骨折中最常见的类型,对于移位的肱骨髁上骨折,闭合复位固定是首选的治疗方案,但是对于选择合适的技术仍存在分歧。因而,此次荟萃分析旨在评估单侧和双侧交叉钉固定对儿童肱骨髁上骨折的疗效,为临床治疗提供...目的:肱骨髁上骨折是儿童肘部骨折中最常见的类型,对于移位的肱骨髁上骨折,闭合复位固定是首选的治疗方案,但是对于选择合适的技术仍存在分歧。因而,此次荟萃分析旨在评估单侧和双侧交叉钉固定对儿童肱骨髁上骨折的疗效,为临床治疗提供参考。方法:全面检索PubMed、Embase、Web of Science和the Cochrane Library建库以来至2023-01-06发表的相关随机对照试验,比较儿童肱骨髁上骨折内外侧交叉固定和单纯外侧固定两种术式的疗效差异,主要观察指标是影像学结果(Baumann角丢失、提携角丢失)、肘关节功能和常见并发症(医源性尺神经损伤、针道感染)。结果:①共纳入18项研究;②两组Baumann角丢失(P=0.47)、提携角丢失(P=0.47)情况相比无统计学差异;外侧固定组与内外侧交叉固定组关节功能恢复评分优秀的患儿比例分别为70.7%和74.9%,差异无显著性意义(P=0.12);两组在针道感染发生率上同样无统计学差异(P=0.9),但内外侧交叉固定组医源性尺神经损伤的风险更高(P=0.02);③然而,当采用小切口联合探查时,内外侧交叉固定组尺神经损伤的频率与外侧固定组相比无统计学差异(P=0.2);④在GartlandⅢ型亚组中,两组在关节功能恢复评分优秀率(P=0.13)、尺神经损伤(P=0.13)和针道感染(P=0.61)方面均无统计学差异。结论:荟萃分析结果显示,与外侧固定技术相比,内外侧交叉固定方法更容易造成前臂的医源性神经损伤,但同时也增加了结构的稳定性。不过,通过小切口方法联合内外侧交叉固定似乎可以降低患者神经损伤的风险。因此,儿童肱骨髁上骨折治疗采用小切口结合内外侧交叉固定可能是一种既保证结构稳定、又安全的固定方法。展开更多
Objective: To retrospectively analyze the effect of unilateral external fixators in the treatment of lower third humeral shaft fractures.Methods: From October 1997 to October 2003, 33 patients aged 15 -70 years (avera...Objective: To retrospectively analyze the effect of unilateral external fixators in the treatment of lower third humeral shaft fractures.Methods: From October 1997 to October 2003, 33 patients aged 15 -70 years (average 31 years) with lower third humeral shaft fractures were treated with unilateral external fixators. There were 9 spiral fractures (type A1), 1 oblique fracture (type A2), 3 transverses fractures (type A3) and 20 comminuted fractures (11 type B1, 9 type B2) according to AO classification. Fifteen cases were treated with open reduction and limited internal fixation and fixation with external fixators, 10 cases treated with open reduction and fixation with external fixators, and 8 cases treated with closed reduction and fixation with external fixators. Nerve exploration was undertaken in 9 cases with preoperative radial nerve injury. External fixators were removed after bone healing. The average follow-up was 18 months with a range from 8 to 24 months. Results: The time of bone healing ranged 11-22 weeks (average 14 weeks). The latest follow-up showed the functions of 9 cases of preoperative radial nerve injury and of 2 cases postoperative radial nerve injury and the function of elbow were recovered to normal. There were only 7 cases of superficial infection at pin hole, which was subsided by using oral antibiotics and pin-hole care with mild disinfectants.Conclusions: Fixation with unilateral external fixators combined with open reduction and limited internal fixation has a good effect in the treatment of lower third humeral shaft fractures.展开更多
Neurapraxia frequently occurs following traction injury to the nerve intraoperatively, leading to radial nerve palsy which usually recovers in 5-30 weeks. In our case, we had operated a distal one-third of humeral sha...Neurapraxia frequently occurs following traction injury to the nerve intraoperatively, leading to radial nerve palsy which usually recovers in 5-30 weeks. In our case, we had operated a distal one-third of humeral shaft fracture and fixed it with 4.5 mm limited contact dynamic compression plate. The distal neurovascular status of the limb was assessed postoperatively in the recovery room and was found to be intact and all the sensory-motor functions of the radial nerve were normal. On the second postoperative day, following the suction drain removal and dressing, patient developed immediate radial nerve palsy along with wrist drop. We reviewed the literature and found no obvious cause for the nerve palsy and concluded that it was due to traction injury to the radial nerve while removing the suction drain in negative pressure.展开更多
目的探讨低频电刺激治疗肱骨干骨折并发桡神经损伤的效果及对患者生活质量的影响。方法选取肱骨骨折术后并发桡神经损伤患者80例,随机分为治疗组和对照组,对照组予常规药物治疗,治疗组在对照组基础上加低频电刺激治疗。治疗前后评定腕...目的探讨低频电刺激治疗肱骨干骨折并发桡神经损伤的效果及对患者生活质量的影响。方法选取肱骨骨折术后并发桡神经损伤患者80例,随机分为治疗组和对照组,对照组予常规药物治疗,治疗组在对照组基础上加低频电刺激治疗。治疗前后评定腕伸肌、指总伸肌肌力,进行肌电图检测,并评估治疗后生活质量(the MOS item short from health survey,SF-36)量表。结果治疗后,治疗组腕伸肌4~5级例数较治疗前明显增多,2组指总伸肌4~5级例数较治疗前明显增多(P<0.05)。治疗后,治疗组腕伸肌、指总伸肌肌力均较对照组明显改善(P<0.05)。治疗后,2组运动神经传导速度(motor nerve conduction velocity,MCV)及波幅值均较治疗前增高(P<0.05)。治疗后,治疗组MCV及波幅值均高于对照组(P<0.05)。治疗后,治疗组社会功能、生理功能、情感职能、精神健康和总体健康评分均高于对照组(P<0.05)。结论低频电刺激治疗可明显提高桡神经损伤患者上肢肌力,改善其运动功能,提高其生活质量。展开更多
文摘BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures.An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness.We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1,2016,and March 31,2020.Subsequently,we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.RESULTS The study included 70 patients who underwent surgical treatment for closed-or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration.The patients suffered from primary(n=5)and secondary(n=5)radial nerve palsy.A 100%radial nerve recovery rate was achieved.The mean recovery time was 4.3 mo.CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment.Surgeons need not be concerned about the occurrence of permanent nerve palsies.
文摘In this article, we present a case of humeral biepicondylar fracture dislocation concomitant with ulnar nerve injury in a seventeen year-old male patient. Physical examination of our patient in the emergency room revealed a painful, edematous and deformed-looking left elbow joint. Hypoesthesia of the little finger was also diagnosed on the left hand. Radiological assessment ended up with a posterior fracture dislocation of the elbow joint accompanied by intra-articular loose bodies. Open reduction-Internal fixation of the fracture dislocation and ulnar nerve exploration were performed under general anesthesia at the same session as surgical treatment of our patient. Physical therapy and rehabilitation protocol was implemented at the end of two weeks post-operatively. Union of the fracture lines, as well as the olecranon osteotomy site, was achieved at the end of four months post-operatively. Ulnar nerve function was fully restored without any sensory or motor loss. Range of motion at the elbow joint was 20-120 degrees at the latest follow-up.
文摘Radial nerve injuries in displaced extension-type supracondylar humeral fractures in children are well known. Entrapment in fracture of radial nerve is uncommon and rarely evocated in literature. We report two similar cases in the mechanism of injury, the clinical findings and the treatment and propose therapeutic guidelines.
文摘Radial nerve palsy is the most common neurological involvement in humeral shaft fractures.But combined radial and median nerve injury in a closed diaphyseal fracture of the humerus is rare.Combined injury to both radial and median nerve can cause significant disability.A detailed clinical examination is therefore necessary following humeral shaft fractures.We report a patient with closed diaphyseal humeral fracture （AO 12A-2.3） together with radial and median nerve palsy,its management and review of the literature.As the patient had two nerves involved,surgical exploration was planned.Fracture was reduced and fixed with a 4.5 mm narrow dynamic compression pla te.There was no external injury to both radial and median nerves on surgical exploration.Neurological recovery started at 3 weeks＇ follow-up.Complete recovery was seen at 12 weeks.Careful clinical examination is of the utmost importance in early diagnosis of combined nerve injuries,which allows better management and rehabilitation of the patient.
文摘目的:肱骨髁上骨折是儿童肘部骨折中最常见的类型,对于移位的肱骨髁上骨折,闭合复位固定是首选的治疗方案,但是对于选择合适的技术仍存在分歧。因而,此次荟萃分析旨在评估单侧和双侧交叉钉固定对儿童肱骨髁上骨折的疗效,为临床治疗提供参考。方法:全面检索PubMed、Embase、Web of Science和the Cochrane Library建库以来至2023-01-06发表的相关随机对照试验,比较儿童肱骨髁上骨折内外侧交叉固定和单纯外侧固定两种术式的疗效差异,主要观察指标是影像学结果(Baumann角丢失、提携角丢失)、肘关节功能和常见并发症(医源性尺神经损伤、针道感染)。结果:①共纳入18项研究;②两组Baumann角丢失(P=0.47)、提携角丢失(P=0.47)情况相比无统计学差异;外侧固定组与内外侧交叉固定组关节功能恢复评分优秀的患儿比例分别为70.7%和74.9%,差异无显著性意义(P=0.12);两组在针道感染发生率上同样无统计学差异(P=0.9),但内外侧交叉固定组医源性尺神经损伤的风险更高(P=0.02);③然而,当采用小切口联合探查时,内外侧交叉固定组尺神经损伤的频率与外侧固定组相比无统计学差异(P=0.2);④在GartlandⅢ型亚组中,两组在关节功能恢复评分优秀率(P=0.13)、尺神经损伤(P=0.13)和针道感染(P=0.61)方面均无统计学差异。结论:荟萃分析结果显示,与外侧固定技术相比,内外侧交叉固定方法更容易造成前臂的医源性神经损伤,但同时也增加了结构的稳定性。不过,通过小切口方法联合内外侧交叉固定似乎可以降低患者神经损伤的风险。因此,儿童肱骨髁上骨折治疗采用小切口结合内外侧交叉固定可能是一种既保证结构稳定、又安全的固定方法。
文摘Objective: To retrospectively analyze the effect of unilateral external fixators in the treatment of lower third humeral shaft fractures.Methods: From October 1997 to October 2003, 33 patients aged 15 -70 years (average 31 years) with lower third humeral shaft fractures were treated with unilateral external fixators. There were 9 spiral fractures (type A1), 1 oblique fracture (type A2), 3 transverses fractures (type A3) and 20 comminuted fractures (11 type B1, 9 type B2) according to AO classification. Fifteen cases were treated with open reduction and limited internal fixation and fixation with external fixators, 10 cases treated with open reduction and fixation with external fixators, and 8 cases treated with closed reduction and fixation with external fixators. Nerve exploration was undertaken in 9 cases with preoperative radial nerve injury. External fixators were removed after bone healing. The average follow-up was 18 months with a range from 8 to 24 months. Results: The time of bone healing ranged 11-22 weeks (average 14 weeks). The latest follow-up showed the functions of 9 cases of preoperative radial nerve injury and of 2 cases postoperative radial nerve injury and the function of elbow were recovered to normal. There were only 7 cases of superficial infection at pin hole, which was subsided by using oral antibiotics and pin-hole care with mild disinfectants.Conclusions: Fixation with unilateral external fixators combined with open reduction and limited internal fixation has a good effect in the treatment of lower third humeral shaft fractures.
文摘Neurapraxia frequently occurs following traction injury to the nerve intraoperatively, leading to radial nerve palsy which usually recovers in 5-30 weeks. In our case, we had operated a distal one-third of humeral shaft fracture and fixed it with 4.5 mm limited contact dynamic compression plate. The distal neurovascular status of the limb was assessed postoperatively in the recovery room and was found to be intact and all the sensory-motor functions of the radial nerve were normal. On the second postoperative day, following the suction drain removal and dressing, patient developed immediate radial nerve palsy along with wrist drop. We reviewed the literature and found no obvious cause for the nerve palsy and concluded that it was due to traction injury to the radial nerve while removing the suction drain in negative pressure.
文摘目的探讨低频电刺激治疗肱骨干骨折并发桡神经损伤的效果及对患者生活质量的影响。方法选取肱骨骨折术后并发桡神经损伤患者80例,随机分为治疗组和对照组,对照组予常规药物治疗,治疗组在对照组基础上加低频电刺激治疗。治疗前后评定腕伸肌、指总伸肌肌力,进行肌电图检测,并评估治疗后生活质量(the MOS item short from health survey,SF-36)量表。结果治疗后,治疗组腕伸肌4~5级例数较治疗前明显增多,2组指总伸肌4~5级例数较治疗前明显增多(P<0.05)。治疗后,治疗组腕伸肌、指总伸肌肌力均较对照组明显改善(P<0.05)。治疗后,2组运动神经传导速度(motor nerve conduction velocity,MCV)及波幅值均较治疗前增高(P<0.05)。治疗后,治疗组MCV及波幅值均高于对照组(P<0.05)。治疗后,治疗组社会功能、生理功能、情感职能、精神健康和总体健康评分均高于对照组(P<0.05)。结论低频电刺激治疗可明显提高桡神经损伤患者上肢肌力,改善其运动功能,提高其生活质量。
