Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2008 Jul;21(3):240-243. Korean.
    Published online Jul 31, 2008.
    https://doi.org/10.12671/jkfs.2008.21.3.240
    Copyright © 2008 The Korean Fracture Society. All rights reserved.
    Case Report

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

    Sang-Uk Lee, M.D., Weon-Yoo Kim, M.D.,* Soo-Hwan Kang, M.D., Yong-Soo Park, M.D. and Seung-Koo Rhee, M.D.
      • Department of Orthopedic Surgery, St. Mary's Hospital, Seoul, Korea.
      • *Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, Daejeon, Korea.
    • Address reprint requests to: Seung-Koo Rhee, M.D. Department of Orthopedic Surgery, St. Mary's Hospital, 62, Yeouido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea. Tel: 82-2-3779-1192, Fax: 82-2-783-0252, Email: skrhee@catholic.ac.kr

    This is an Open Access article distributed 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 original work is properly cited.

    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.

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

    Figures

    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.

    Tables

    Table 1
    Summary of cases

    References

      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.
      1. Chiu DT, Janecka I, Krizek TJ, Wolff M, Lovelace RE. Autogenous vein graft as a conduit for nerve regeneration. Surgery 1982;91:226–233.
      1. 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.
      1. Lowe JB 3rd, Sen SK, Mackinnon SE. Current approach to radial nerve paralysis. Plast Reconstr Surg 2002;110:1099–1113.
      1. Millesi H. The nerve gap. Theory and clinical practice. Hand Clin 1986;2:651–663.
      1. Myckatyn TM, Mackinnon SE. A review of research endeavors to optimize peripheral nerve reconstruction. Neurol Res 2004;26:124–138.
      1. Olarte CM, Darowish M, Ziran BH. Radial nerve transposition with humeral fracture fixation: preliminary results. Clin Orthop Relat Res 2003;413:170–174.
      1. 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.
      1. Samardzić M, Grujicić D, Milinković ZB. Radial nerve lesions associated with fractures of the humeral shaft. Injury 1990;21:220–222.
      1. Scholz R. Radial nerve transposition in plate osteosynthesis of humeral-shaft fractures in the median third. Hefte Unfallheilkd 1975;126:363–365.
      1. Terzis JK, Smith KJ. Repair of severed peripheral nerves: comparison of the "de Medinaceli" and standard microsuture methods. Exp Neurol 1987;96:672–680.
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    MeSH Terms
    Fractures, Comminuted
    Humerus
    Radial Nerve
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