J Korean Fract Soc.  2008 Jul;21(3):240-243. 10.12671/jkfs.2008.21.3.240.

Medial Transposition of Radial Nerve in Distal Humerus Shaft Fracture: A Report of Six Cases

• Lee SU
• Kim WY
• Kang SH
• Park YS
• Rhee SK

• KMID: 2015448
• DOI: http://doi.org/10.12671/jkfs.2008.21.3.240

Abstract

Sometimes serious tension occurs in the radial nerve when doing internal fixation for distal humerus shaft fracture or neurorrhaphy for radial nerve injury. Medial transposition of radial nerve on fracture site can avoid direct radial nerve injury by fracture fragment, radial nerve tension by plating for distal humerus shaft fracture, and also safe from neural tension during neurorrhaphy of damaged radial nerve. We reported here total 6 cases of backward transposition of radial nerve including 2 cases of radial nerve injury associated with humerus fracture and 4 cases of comminuted fracture of humerus shaft.

Keyword

Humerus; Radial nerve; Distal shaft fracture; Nerve injury; Medial transposition

MeSH Terms

Fractures, Comminuted
Humerus
Radial Nerve

Figure

• 

  Fig. 1 (A) Clinical photograph showing complete rupture of radial nerve with nerve gap. (B) After removal of plate & screws, 2 cm nerve gap was found. (C) After sufficient mobilization, and neurorrhaphy of ruptured radial nerve through fracture site, the nerve (arrow) was transposed on backside of humerus without tension.

• 

  Fig. 2 (A) Plain X-ray & CT image showing distal humerus comminuted fracture extending to articular surface. (B) Radial nerve (arrow) overlying fracture site in the operative findings. (C) Clinical photograph showing radial nerve without tension behind fracture site after plate fixation and medial transposition of nerve. (D) Postoperatively, X-ray shows good reduction without neurologic deficits.

Reference

1. Bono CM, Grossman MG, Hochwald N, Tornetta P 3rd. Radial and axillary nerves. Anatomic considerations for humeral fixation. Clin Orthop Relat Res. 2000; 373:259–264.

2. Chiu DT, Janecka I, Krizek TJ, Wolff M, Lovelace RE. Autogenous vein graft as a conduit for nerve regeneration. Surgery. 1982; 91:226–233.

3. El Ayoubi L, Karmouta A, Roussignol X, Auquit-Auckbur I, Milliez PY, Duparc F. Anterior radial nerve transposition in humerus midshaft fractures: anatomic and clinical study. Rev Chir Orthop Reparatrice Appar Mot. 2003; 89:537–543.

4. Lowe JB 3rd, Sen SK, Mackinnon SE. Current approach to radial nerve paralysis. Plast Reconstr Surg. 2002; 110:1099–1113.

5. Millesi H. The nerve gap. Theory and clinical practice. Hand Clin. 1986; 2:651–663.

6. Myckatyn TM, Mackinnon SE. A review of research endeavors to optimize peripheral nerve reconstruction. Neurol Res. 2004; 26:124–138.

7. Olarte CM, Darowish M, Ziran BH. Radial nerve transposition with humeral fracture fixation: preliminary results. Clin Orthop Relat Res. 2003; 413:170–174.

8. Pollock RC, Birch R. Complete transposition of the radial nerve complicating an open fracture of the shaft of the humerus. Injury. 1999; 30:623–625.

9. Samardzić M, Grujicić D, Milinković ZB. Radial nerve lesions associated with fractures of the humeral shaft. Injury. 1990; 21:220–222.

10. Scholz R. Radial nerve transposition in plate osteosynthesis of humeral-shaft fractures in the median third. Hefte Unfallheilkd. 1975; 126:363–365.

11. Terzis JK, Smith KJ. Repair of severed peripheral nerves: comparison of the "de Medinaceli" and standard microsuture methods. Exp Neurol. 1987; 96:672–680.