Radial Nerve Injury after Anterograde and Retrograde Locked Intramedullary Nailing of Humerus. A Clinical and Anatomical Study

Introduction

While most humeral shaft fractures are usually best managed conservatively, those with non-union, transverse fractures, comminuted fractures and pathological fractures may be treated using an interlocking intramedullary nail (Table [1]). Most of the available implants can be applied both by anterograde and retrograde techniques. The anterograde insertion technique may hurt the rotator cuff and the cartilage of the humeral head resulting in shoulder pain and loss of joint function. Distal latero-medial interlocking after antero- and retrograde nailing however, can lead to post-operative radial nerve palsy. The purpose of this study was to determine the incidence of radial nerve injury after distal interlocking in retrograde and anterograde insertion techniques with the AO-Unreamed-Humeral Nail (UHN, see Fig. [1]).

Table 1 Indications for operative treatment primary radial nerve palsy secondary radial nerve palsy (after primary conservative treatment) chain injury open fractures (with concomitant nerve/vessel injury) bilateral fractures polytrauma non-unions pathological fractures

The results of the anatomic tests were studied and compared to clinical results.

Fig. 1 AO - Unreamed humeral nail (UHN).

References

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