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Multicenter Study
. 2020 Aug;34(8):441-446.
doi: 10.1097/BOT.0000000000001755.

What is the Real Rate of Radial Nerve Injury After Humeral Nonunion Surgery?

Justin Koh  1 , Paul Tornetta 3rd  1 , Brock Walker  2 , Clifford Jones  2 , Tayseer Sharmaa  3 , Stephen Sems  3 , Kathleen Ringenbach  4 , Henry Boateng  4 , Kate Bellevue  5 , Reza Firoozabadi  5 , Clay Spitler  6 , Sharul Saxena  7 , Lisa Cannada  7 , Amrut Borade  8 , Daniel Horwitz  8 , J Stewart Buck  9 , Michael Bosse  9 , Jerald R Westberg  10 , Andrew Schmidt  10 , Laurence Kempton  11 , Emily Newcomb  12 , Andrew Marcantonio  12 , Matthew Delarosa  13 , Peter Krause  13 , Andrew Gudeman  14 , Brian Mullis  14 , Amro Alhoukail  15 , Ross Leighton  15 , Abigail Cortez  16 , Saam Morshed  16 , Christina Tieszer  17 , David Sanders  17 , Shaan Patel  18 , Hassan R Mir  18
Affiliations
Multicenter Study

What is the Real Rate of Radial Nerve Injury After Humeral Nonunion Surgery?

Justin Koh et al. J Orthop Trauma. 2020 Aug.

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.

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