Shaft of Humerus fracture with Radial Nerve Palsy
How do you approach a patient with shaft of himerus fracture with radial nerve palsy?
Approach based on ATLS.
Exclude other injuries - NV, Open wounds, compartment syndrome
AMPLE History
Analgesia
Splinting
Collar and Cuff with gravity traction
Fracture can be managed non-operative or operatively based on fracture displacement and fracture geometry
https://nerveclinic.co.uk/nerve-injuries/nerve-injury-after-fracture-or-dislocation
Early Immediate Exploration Criteria for Radial Nerve Injury
(https://www.aofoundation.org/trauma/about-aotrauma/blog/2023_03- blog-moharram-lambert-radial-nerve-palsy)
Open Fractures with Radial Nerve Palsy
High velocity injuries - Gunshot wounds, Penetrating wounds, Severe soft tissue damage
Neurotemesis (complete transection ) signalled by loss of Brachioradialis function, finger and wrist drop
There is no need of exploring the nerve nerve while fixing the humerus if there are no indications.
Otherwise we manage the Radial Nerve expectantly.
90 % - Neuropraxia and recover within 3-4 months.
Wrist splint( in extension ) for wrist drop
Physiotherapy - to maintain range of motion.
If radial nerve palsy does not improve after 4 months, what will you do ?
Nerve conduction , EMG studies.
If neuroproaxia - continue to monitor expectantly.
If muscle denervated, action potential - Fibrillation potential on EMGs.
Refer to local peripheral nerve injury specialist.
Principles of tendon transfer
1. Supple joint with full ROM
2. Donor should be healthy and expendable.
Grade 5 , MRC Power
Adequate Excursion
Synergist
Straight line of pull
3. Recipient - tendon of paralyzed muscle
4. Common transfer
ECRB to supplement by Pronator Teres
Palmaris longus (PL) by EPL
Flexor Carpi Radialis (FCR) by ED
Comments
Post a Comment