What is the real rate of radial nerve injury after humeral nonunion surgery?

Justin Koh, Paul Tornetta, Brock Walker, Clifford Jones, Tayseer Sharmaa, Stephen Sems, Kathleen Ringenbach, Henry Boateng, Kate Bellevue, Reza Firoozabadi, Clay Spitler, Sharul Saxena, Lisa Cannada, Amrut Borade, Daniel Horwitz, J. Stewart Buck, Michael Bosse, Jerald R. Westberg, Andrew Schmidt, Laurence KemptonEmily Newcomb, Andrew Marcantonio, Matthew Delarosa, Peter Krause, Andrew Gudeman, Brian Mullis, Amro Alhoukail, Ross Leighton, Abigail Cortez, Saam Morshed, Christina Tieszer, David Sanders, Shaan Patel, Hassan R. Mir

Research output: Contribution to journalArticle

Abstract

Objectives:To determine the radial nerve palsy (RNP) rate and predictors of injury after humeral nonunion repair in a large multicenter sample.Design:Consecutive retrospective cohort review.Setting:Eighteen academic orthopedic trauma centers.Patients/Participants:Three hundred seventy-nine adult patients who underwent humeral shaft nonunion repair. Exclusion criteria were pathologic fracture and complete motor RNP before nonunion surgery.Intervention:Humeral shaft nonunion repair and assessment of postoperative radial nerve function.Main Outcome:Measurements: Demographics, nonunion characteristics, preoperative and postoperative radial nerve function and recovery.Results:Twenty-six (6.9%) of 379 patients (151 M, 228 F, ages 18-93 years) had worse radial nerve function after nonunion repair. This did not differ by surgical approach. Only location in the middle third of the humerus correlated with RNP (P = 0.02). A total of 15.8% of patients with iatrogenic nerve injury followed for a minimum of 12 months did not resolve. For those who recovered, resolution averaged 5.4 months. On average, partial/complete palsies resolved at 2.6 and 6.5 months, respectively. Sixty-one percent (20/33) of patients who presented with nerve injury before their nonunion surgery resolved.Conclusion:In a large series of patients treated operatively for humeral shaft nonunion, the RNP rate was 6.9%. Among patients with postoperative iatrogenic RNP, the rate of persistent RNP was 15.8%. This finding is more generalizable than previous reports. Midshaft fractures were associated with palsy, while surgical approach was not.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)441-446
Number of pages6
JournalJournal of orthopaedic trauma
Volume34
Issue number8
DOIs
StatePublished - Aug 1 2020

Keywords

  • humerus
  • nonunion
  • palsy
  • radial nerve
  • recovery
  • repair

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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  • Cite this

    Koh, J., Tornetta, P., Walker, B., Jones, C., Sharmaa, T., Sems, S., Ringenbach, K., Boateng, H., Bellevue, K., Firoozabadi, R., Spitler, C., Saxena, S., Cannada, L., Borade, A., Horwitz, D., Buck, J. S., Bosse, M., Westberg, J. R., Schmidt, A., ... Mir, H. R. (2020). What is the real rate of radial nerve injury after humeral nonunion surgery? Journal of orthopaedic trauma, 34(8), 441-446. https://doi.org/10.1097/BOT.0000000000001755