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Journal of Orthopaedic Surgery and... May 2022Open reduction and internal fixation through the posterior approach are standard methods for treating middle-inferior humerus fractures. Given the limited operative...
BACKGROUND AND PURPOSE
Open reduction and internal fixation through the posterior approach are standard methods for treating middle-inferior humerus fractures. Given the limited operative field and difficulty in locating the radial nerve, the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique via the posterior approach to treat middle-inferior humerus fractures has rarely been reported. This study aims to evaluate the clinical effect of the preoperative study of the radial nerve position by B-ultrasound and its intraoperative protection combined with MIPPO in managing middle-inferior humerus fractures.
METHODS
The data were studied retrospectively involving 64 participants who had surgery for middle-inferior humerus fractures from the start of 2017 to the end of 2020. Participants were divided into two groups, those treated with the MIPPO technique, including newly developed dual procedures and preoperative position and protection of radial nerve by B-ultrasound (group A), and those treated with open reduction and internal plating fixation (group B).
RESULTS
All the cases were followed up for 12-34 months (an average of 25.6 ± 8.76 months), and there was no significant difference in the mean operative duration, surgical incision infection, range of motion (ROM) and MEPS (Mayo elbow performance score) for groups A and B. However, the occurrence of complications (radial nerve palsy, bone nonunion and flexible internal fixation or ruptures) in group B was significantly higher than the group A. A statistically significant difference was observed in the intraoperative blood loss, hospital stay and fracture nonunion time between the two groups. All the cases gained bone union within the MIPPO group.
CONCLUSION
MIPPO via the posterior dual approach associated with preoperative position and protection of radial nerve by B-ultrasound does not increase radial nerve injury, however, it exhibits obvious advantages in the bone union, which is worthy of clinical application.
Topics: Bone Plates; Fracture Fixation, Internal; Humans; Humeral Fractures; Humerus; Minimally Invasive Surgical Procedures; Radial Nerve; Retrospective Studies; Treatment Outcome
PubMed: 35551620
DOI: 10.1186/s13018-022-03149-7 -
Neurological Research Jan 2020: Polyneuropathy is the most common neurological complication in primary Sjögren's syndrome (pSS). A ratio of sural nerve and superficial radial nerve sensorial action...
: Polyneuropathy is the most common neurological complication in primary Sjögren's syndrome (pSS). A ratio of sural nerve and superficial radial nerve sensorial action potential amplitudes (SRARs) of <0.4 is an indicator for early axonal neuropathy. We evaluated the polyneuropathies and SRARs in pSS patients.: Fifty-two female patients who were diagnosed with pSS according to the European-American Consensus Criteria and 45 healthy controls were enrolled. Nerve conduction studies were performed to diagnose polyneuropathy. Sensory axonal polyneuropathy was diagnosed in three patients, so SRARs were compared in 49 patients and 50 healthy controls.: Fifty-two patients with pSS underwent nerve conduction tests. The sural sensory nerve action potential (SNAP) was <6 µV in threepatients and they were diagnosed with sensory axonal neuropathy. SRARs were evaluated in 49 female patients, with a mean age of 51.98 ± 10.79 years and 50 healthy controls with a mean age of 50.52 ± 12.55 years. The mean disease duration was 7.59 ± 6.17 years. The SRAR values were different between the patient and control groups. SRAR was <0.4 in 20.4% of the patient group and <0.4 in 6% of the control group. The SRAR value was not statistically different within the patient group based on anti-Ro and anti-La.: The potential for neurological involvement in patients with pSS who have no signs or injury should be evaluated because nervous system involvement in pSS is a negative prognostic factor. SRAR in patients with pSS can be used as a marker for the early detection of axonal neuropathy.
Topics: Action Potentials; Adult; Electrodiagnosis; Female; Humans; Middle Aged; Neural Conduction; Polyneuropathies; Prospective Studies; Radial Nerve; Sjogren's Syndrome; Sural Nerve
PubMed: 31661424
DOI: 10.1080/01616412.2019.1680126 -
Journal of Taibah University Medical... Oct 2020This study examined variations in the termination level of the radial nerve (RN) and the morphometry of the RN and its branches at potential compression sites....
OBJECTIVES
This study examined variations in the termination level of the radial nerve (RN) and the morphometry of the RN and its branches at potential compression sites. Additionally, we digitally analysed histological sections of the RN, the superficial branch of the radial nerve (SBRN), and the posterior interosseous nerve (PIN).
METHODS
We conducted this study on 14 formalin fixed adult cadavers. The lengths of the RN, SBRN, and PIN were measured up to potential compression sites, using appropriate surface skeletal landmarks as reference points. We histologically evaluated the fascicular and non-fascicular areas and the number of axons in each nerve. All parameters were statistically analysed using a paired t-test.
RESULTS
We found variations in the bifurcation of the RN with respect to the biepicondylar line (BEL). However, the course of RN terminal branches was constant in the forearm. There was a significant histological difference between the fascicular and non-fascicular areas of the PIN. There was no significant difference in the total number of axons in the SBRN and PIN. Finally, we observed that the intramuscular length of the PIN within the supinator muscle was variable and that the SBRN had more fascicles compared to the RN and PIN.
CONCLUSIONS
In our study, the RN and PIN had more variable morphometry compared to that of the SBRN. The histologic evaluation and quantification of these nerves at their potential compression sites could serve as a guide for surgeons planning nerve reconstruction procedures.
PubMed: 33132807
DOI: 10.1016/j.jtumed.2020.07.009 -
Children (Basel, Switzerland) Nov 2023Up to 12% of paediatric supracondylar humerus fractures (SCHFs) have an associated traumatic nerve injury. This review aims to summarize the evidence and guide... (Review)
Review
Up to 12% of paediatric supracondylar humerus fractures (SCHFs) have an associated traumatic nerve injury. This review aims to summarize the evidence and guide clinicians regarding the timing of investigations and/or surgical interventions for traumatic nerve palsies after this injury. A formal systematic review was undertaken in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews and PRISMA guidelines. Manuscripts were reviewed by independent reviewers against the inclusion and exclusion criteria, and data extraction, synthesis, and assessment for methodological quality were undertaken. A total of 51 manuscripts were included in the final evaluation, reporting on a total of 510 traumatic nerve palsies in paediatric SCHFs. In this study, 376 nerve palsies recovered without any investigation or intervention over an average time of 19.5 weeks. Comparatively, 37 went back to theatre for exploration beyond the initial treatment due to persistent deficits, at an average time of 4 months. The most common finding at the time of exploration was entrapment of the nerve requiring neurolysis. A total of 27 cases did not achieve full recovery regardless of management. Of the 15 reports of nerve laceration secondary to paediatric SCHFs, 13 were the radial nerve. Most paediatric patients who sustain a SCHF with associated traumatic nerve injury will have full recovery. Delayed or no recovery of the nerve palsy should be considered for exploration within four months of the injury; earlier exploration should be considered for radial nerve palsies.
PubMed: 38136064
DOI: 10.3390/children10121862 -
Journal of Neurosurgery May 2022The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach.
OBJECTIVE
The authors sought to describe the anatomy of the radial nerve and its branches when exposed through an axillary anterior arm approach.
METHODS
Bilateral upper limbs of 10 fresh cadavers were dissected after dyed latex was injected into the axillary artery.
RESULTS
Via the anterior arm approach, all triceps muscle heads could be dissected and individualized. The radial nerve overlaid the latissimus dorsi tendon, bounded by the axillar artery on its superior surface, then passed around the humerus, together with the lower lateral arm and posterior antebrachial cutaneous nerve, between the lateral and medial heads of the triceps. No triceps motor branch accompanied the radial nerve's trajectory. Over the latissimus dorsi tendon, an antero-inferior bundle, containing all radial nerve branches to the triceps, was consistently observed. In the majority of the dissections, a single branch to the long head and dual innervations for the lateral and medial heads were observed. The triceps long and proximal lateral head branches entered the triceps muscle close to the latissimus dorsi tendon. The second branch to the lateral head stemmed from the triceps lower head motor branch. The triceps medial head was innervated by the upper medial head motor branch, which followed the ulnar nerve to enter the medial head on its anterior surface. The distal branch to the triceps medial head also originated near the distal border of the latissimus dorsi tendon. After a short trajectory, a branch went out that penetrated the medial head on its posterior surface. The triceps lower medial head motor branch ended in the anconeus muscle, after traveling inside the triceps medial head. The lower lateral arm and posterior antebrachial cutaneous nerve followed the radial nerve within the torsion canal. The lower lateral brachial cutaneous nerve innervated the skin over the biceps, while the posterior antebrachial cutaneous nerve innervated the skin over the lateral epicondyle and posterior surface of the forearm. The average numbers of myelinated fibers were 926 in the long and 439 in the upper lateral head and 658 in the upper and 1137 in the lower medial head motor branches.
CONCLUSIONS
The new understanding of radial nerve anatomy delineated in this study should aid surgeons during reconstructive surgery to treat upper-limb paralysis.
PubMed: 34624848
DOI: 10.3171/2021.4.JNS2169 -
Hand (New York, N.Y.) Jul 2023The purpose of this study was to compare the 1,2 with a novel 2R portal in terms of proximity to critical structures.
BACKGROUD
The purpose of this study was to compare the 1,2 with a novel 2R portal in terms of proximity to critical structures.
METHODS
Wrist arthroscopy was performed on 8 fresh frozen cadavers via the 1,2 and 2R portals. External anatomy was then dissected under loupe magnification. The closest distance between the portals and surrounding anatomical structures was measured in millimeters using digital calipers.
RESULTS
The 1,2 portal was significantly closer to radial artery and first extensor compartment tendons than the 2R portal. The radial artery was on average 1.32 mm from the 1-2 portal and 14.25 mm from the 2R portal. The 2R portal was significantly closer to the second and third extensor compartment tendons. The closest branch of the superficial branch of the radial nerve (SBRN) was on average 2.04 mm from the 1-2 portal and 7.59 mm from the 2R portal, but this was not statistically significant.
CONCLUSIONS
We advocate using the 2R portal preferentially to the 1,2 portal when treating radial sided wrist pathology to decrease the risk of iatrogenic radial artery and SBRN injury.
Topics: Humans; Wrist; Arthroscopy; Wrist Joint; Radial Artery; Radial Nerve
PubMed: 35144498
DOI: 10.1177/15589447221075668 -
Journal of Clinical Medicine Mar 2024: This study investigates the surgical state-of-the-art procedure for humeral shaft fractures with primary radial nerve palsy based on its own case series in relation to...
: This study investigates the surgical state-of-the-art procedure for humeral shaft fractures with primary radial nerve palsy based on its own case series in relation to the current and established literature. : Retrospective review of treated cases between January 2018 and December 2022 describing radial nerve palsy after humerus shaft fractures, radiological fracture classification, intraoperative findings, surgical procedure, patient follow-up and functional outcome. : A total of 804 patients (463 women and 341 men) with humerus shaft fractures were identified. A total of 33 patients showed symptomatic lesions of the radial nerve (4.1%). The primary lesion was identified in 17 patients (2.1%). A broad and inhomogeneous distribution of fractures according to the AO classification was found. According to the operative reports, the distraction of the radial nerve was found eleven times, bony interposed three times and soft tissue constricted/compressed three times. In every case the radial nerve was surgically explored, there was no case of complete traumatic nerve transection. Four intramedullary nails and thirteen locking plates were used for osteosynthesis. Complete recovery of nerve function was seen in 12 cases within 1 to 36 months. Three patients still showed mild hypesthesia in the thumb area after 18 months. Two patients were lost during follow-up. : With this study, we support the strategy of early nerve exploration and plate osteosynthesis in humeral fractures with primary radial nerve palsy when there is a clear indication for surgical fracture stabilisation. In addition, early exploration appears sensible in the case of palsies in open fractures and secondary palsy following surgery without nerve exposure as well as in the case of diagnostically recognisable nerve damage. Late nerve exploration is recommended if there are no definite signs of recovery after 6 months. An initial wait-and-see strategy with clinical observation seems reasonable for primary radial nerve palsies without indication for surgical fracture stabilisation.
PubMed: 38610658
DOI: 10.3390/jcm13071893 -
Cell and Tissue Research Nov 2023The potential to regenerate a damaged body part is expressed to a different extent in animals. Echinoderms, in particular starfish, are known for their outstanding...
The potential to regenerate a damaged body part is expressed to a different extent in animals. Echinoderms, in particular starfish, are known for their outstanding regenerating potential. Differently, humans have restricted abilities to restore organ systems being dependent on limited sources of stem cells. In particular, the potential to regenerate the central nervous system is extremely limited, explaining the lack of natural mechanisms that could overcome the development of neurodegenerative diseases and the occurrence of trauma. Therefore, understanding the molecular and cellular mechanisms of regeneration in starfish could help the development of new therapeutic approaches in humans. In this study, we tackle the problem of starfish central nervous system regeneration by examining the external and internal anatomical and behavioral traits, the dynamics of coelomocyte populations, and neuronal tissue architecture after radial nerve cord (RNC) partial ablation. We noticed that the removal of part of RNC generated several anatomic anomalies and induced behavioral modifications (injured arm could not be used anymore to lead the starfish movement). Those alterations seem to be related to defense mechanisms and protection of the wound. In particular, histology showed that tissue patterns during regeneration resemble those described in holothurians and in starfish arm tip regeneration. Flow cytometry coupled with imaging flow cytometry unveiled a new coelomocyte population during the late phase of the regeneration process. Morphotypes of these and previously characterized coelomocyte populations were described based on IFC data. Further studies of this new coelomocyte population might provide insights on their involvement in radial nerve cord regeneration.
Topics: Animals; Humans; Radial Nerve; Starfish; Nerve Regeneration; Sea Cucumbers
PubMed: 37606764
DOI: 10.1007/s00441-023-03818-x -
Muscle & Nerve Mar 2022Optimal timing of nerve transfer surgery in cervical spinal cord injury (SCI) depends upon the integrity of lower motor neurons (LMNs) in recipient nerves, which is best... (Observational Study)
Observational Study
INTRODUCTION/AIMS
Optimal timing of nerve transfer surgery in cervical spinal cord injury (SCI) depends upon the integrity of lower motor neurons (LMNs) in recipient nerves, which is best predicted by compound muscle action potential (CMAP) amplitude. There are no established techniques for obtaining the CMAP in two recipient muscles: triceps brachii and extensor carpi radialis longus (ECRL). This study aimed to develop recording techniques for radial motor studies to triceps and ECRL, and to determine reference values for CMAP amplitudes in healthy volunteers.
METHODS
This was a prospective observational study of healthy adults aged 18 years and older. Motor nerve conduction studies were performed, stimulating the radial nerve in the axilla, over the axillary pulse at the pectoralis major insertion. Recording was from triceps (long head) and ECRL. CMAP amplitude, area, latency, and stimulus intensity were recorded. Reference values (RV) were calculated for CMAP amplitudes using a value 2 standard deviations below the mean. Cube root or logarithmic transformations were used to correct for non-normal distributions.
RESULTS
Twenty-five healthy subjects participated. Triceps mean CMAP amplitude was 15.5 mV (SD 4.19), with an RV of 8.1 mV. ECRL mean CMAP amplitude was 11.5 mV (SD 3.54), with an RV of 6.2 mV. CMAP amplitude at ECRL was 75% (95% confidence interval 50%-100%) of that at triceps.
DISCUSSION
We describe a technique for recording radial motor NCS from triceps and ECRL. Knowledge of normal CMAP amplitudes will help identify LMN injury in patients with cervical SCI being considered for nerve transfers.
Topics: Action Potentials; Adolescent; Adult; Arm; Forearm; Humans; Muscle, Skeletal; Nerve Transfer; Neural Conduction; Radial Nerve; Reference Values
PubMed: 34862799
DOI: 10.1002/mus.27470 -
Scientific Reports Aug 2021Identification of the radial nerve is important during the posterior approach to a humerus fracture. During this procedure, the patient can be placed in the prone or...
Identification of the radial nerve is important during the posterior approach to a humerus fracture. During this procedure, the patient can be placed in the prone or lateral decubitus position depending on the surgeon's preference. The distance from the radial nerve to the osseous structures will be different in each position. The purpose of this study was to identify the safety zones in various patient and elbow flexion positions. The distances from the olecranon to the center of the radial groove and intermuscular septum and lateral epicondyle to the lateral intermuscular septum were measured using a digital Vernier caliper. The measurements were performed with cadavers in the lateral decubitus and prone positions at different elbow flexion angles. The distance from where the radial nerve crossed the posterior aspect of the humerus measured from the upper part of the olecranon to the center of the radial nerve in both positions at different elbow flexion angles varied from a mean maximum distance of 130.00 mm with the elbow in full extension in the prone position to a minimum distance of 121.01 mm with the elbow in flexion at 120° in the lateral decubitus position. The mean distance of the radial nerve from the upper olecranon to the lateral intermuscular septum varied from 107.13 to 102.22 mm. The distance from the lateral epicondyle to the lateral edge of the radial nerve varied from 119.92 to 125.38 mm. There was not significant contrast in the position of the radial nerve with osseous landmarks concerning different degrees of flexion, except for 120°, which is not significant, as this flexion angle is rarely used.
Topics: Aged; Cadaver; Elbow; Elbow Joint; Female; Humans; Humeral Fractures; Humerus; Male; Models, Anatomic; Posture; Prone Position; Radial Nerve; Range of Motion, Articular
PubMed: 34446749
DOI: 10.1038/s41598-021-96458-6