[A comparision of the prevalence of radial nerve lesion after fixation of humeral shaft fractures with dynamic compression plate versus intramedullary nailing]

Abstract

Material and methods: We conducted this study in the thoracic extremity surgery module, from the Trauma and Orthopedic Surgery Hospital "Lomas Verdes" of the Instituto Mexicano del Seguro Social (IMSS) from September 2001 to 2004. Eighty-seven patients were included with ages between 16 to 81 years, with the diagnosis of humeral shaft fracture without previous neurologic lesion and were treated with intramedullary nail or dynamic compression plate (DCP) with a 2 year follow up.

Results: Eighty seven patients were evaluated; mean age 42.2 +/- 3.2 years; male gender (61%) vs. female gender (39%) (p<0.05); more frequently affected extremity: left (59.7) vs. right (40.3%); acute period fracture: 59.7%; non union 25.3% and delay of consolidation: 15%. Implant used: DCP plate (80%) vs. intramedullary nailing (20%) (p<0.05%). Radial nerve lesion at the beginning and end of the study: 15 (22%) of 70 patients vs. 1 (5.5%) of 17 patients operated with DCP plate vs. intramedullary nail respectively. Of the 16 radial nerve lesions on total (100%), 12 presented with neuroapraxia (10.4%) that included a patient treated with intramedullary nailing and 4 (3.4%) axonotmesis treated with open reduction and internal fixation with DCP.

Conclusion: The preference of treatment on our hospital is the use of DCP in humeral shaft fractures. The surgical technique with DCP represents a higher incidence of radial nerve lesion probably due to the exposure and proximity to the radial nerve during surgery. It will be necessary to verify these results in a clinical controlled trial.