Date: Sun, 18 Aug 2002 13:00:11 -0400
From: Robert A Hymes
Subject: Humeral Shaft Fx + Post Op Radial Nerve Palsy
I would appreciate opinions on this case. Young male with R distal humerus fx secondary to fall from height. Pre-op radial nerve intact. Operative procedure: posterior approach with mobilization of triceps medially (Gerwin, Hotchkiss, JBJS (78), 1996). Radial nerve visualized and protected/retracted. Posterior plating with broad 4.5 mm DCP. Radial nerve on top of plate at closure. In recovery room and post op day #1, patient has normal function of radial nerve. Initial follow-up visit missed. Now presents at 3 weeks with sensory and motot radial nerve palsy. States that hand gradually "went to sleep" about 1 week after leaving the hospital.
I have seen 1 case of nerve under plate. My plate is definitely under nerve. My plan is to explore patient, perhaps release lateral intermuscular septum. Is there any role for observation or additional studies?
Robert Hymes, MD
Date: Sun, 18 Aug 2002 19:30:42 +0100
From: chris wilson
If the nerve is in physical continuity, how will further early exploration help? If the injury is due to a gradual onset neuropraxia, haematoma or irritation by the plate, how can you physically alter things? Exploration will only add to the insult.
Nerve conduction studies now and in 6 weeks would be the choice in this unit, if only to reassure you that there is some conduction, and to show a positive trend before any clinical recovery.
Knee and Trauma Surgeon
Date: Sun, 18 Aug 2002 22:10:44 -0400
From: Clifford B. Jones, M.D.
Agree, observe ... EMG at 6 wks. Expect 6 mo to recover.
Date: Mon, 19 Aug 2002 08:04:02 -0500
From: Obremskey, William T
I would observe.
Did he have a post op splint? I have seen a patient develop a radial nerve palsy due to sleeping on his arm and splint pressure causing a palsy proximally.