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. 2024 Jun;30(6):451-457.
doi: 10.14744/tjtes.2024.49500.

In cases of humeral diaphyseal fractures, is lateral approach surgery without radial nerve exploration as effective and safe as conventional surgery?

Necati Doğan  1 , Cafer Özgür Hançerli  2 , Halil Büyükdoğan  3 , Cemil Ertürk  4
Affiliations

In cases of humeral diaphyseal fractures, is lateral approach surgery without radial nerve exploration as effective and safe as conventional surgery?

Necati Doğan et al. Ulus Travma Acil Cerrahi Derg. 2024 Jun.

Abstract

Background: This study compares the efficacy and safety of lateral approach surgery with and without radial nerve dissection in treating humeral diaphyseal fractures. It assesses clinical, radiological, and complication outcomes, providing a description of the surgical methods and perioperative benefits.

Methods: We retrospectively analyzed data from 71 patients admitted between May 2015 and December 2022 who underwent lateral approach surgery for humeral diaphyseal fractures. Group 1, consisting of 34 patients without radial nerve dissection, and Group 2, comprising 37 patients with radial nerve dissection, were compared. Parameters such as age, gender, fracture side (right/left), fracture type, follow-up time, surgical duration, blood loss, radiological and clinical evaluations (including Shoulder-Elbow range of motion [ROM] and Quick Disabilities of the Arm, Shoulder, and Hand score [Q-DASH]), and complications were examined. Surgical techniques and outcomes were documented.

Results: Both groups exhibited comparable distributions in age, gender, fracture types, and follow-up times (p>0.05). Group 1 demonstrated significantly lower surgical duration and blood loss compared to Group 2 (p<0.05 for both). Clinical assessment revealed satisfactory shoulder and elbow ROM within functional limits for all patients, with no instances of infection. Q-DASH scores were similar between groups. Postoperative radial nerve palsy occurred in one patient in Group 1 and three patients in Group 2, with all cases resolving uneventfully during outpatient follow-ups. Radiological assessment confirmed uneventful union in all patients.

Conclusion: Lateral approach surgery without radial nerve dissection for humeral diaphyseal fractures offers comparable effectiveness and safety to conventional surgery, with potential perioperative advantages such as reduced operation time and blood loss.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Determination of the radial nerve trace using a ruler for measurement.
Figure 2
Figure 2
Reduction and temporary fixation of the fracture.
Figure 3
Figure 3
Perioperative images of radial nerve tracing area retraction.
Figure 4
Figure 4
Fixation of the distal screws using the S retractor-plate hole technique, without dissecting the radial nerve (perioperative views from two different patients).
Figure 5
Figure 5
Preoperative and postoperative radiological images.
See this image and copyright information in PMC

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