What is the real rate of radial nerve injury after humeral nonunion surgery?

Justin Koh; Paul Tornetta; Brock Walker; Clifford Jones; Tayseer Sharmaa; Stephen Sems; Kathleen Ringenbach; Henry Boateng; Kate Bellevue; Reza Firoozabadi; Clay Spitler; Sharul Saxena; Lisa Cannada; Amrut Borade; Daniel Horwitz; J. Stewart Buck; Michael Bosse; Jerald R. Westberg; Andrew Schmidt; Laurence Kempton; Emily Newcomb; Andrew Marcantonio; Matthew Delarosa; Peter Krause; Andrew Gudeman; Brian Mullis; Amro Alhoukail; Ross Leighton; Abigail Cortez; Saam Morshed; Christina Tieszer; David Sanders; Shaan Patel; Hassan R. Mir

doi:10.1097/BOT.0000000000001755

What is the real rate of radial nerve injury after humeral nonunion surgery?

Justin Koh, Paul Tornetta, Brock Walker, Clifford Jones, Tayseer Sharmaa, Stephen Sems, Kathleen Ringenbach, Henry Boateng, Kate Bellevue, Reza Firoozabadi, Clay Spitler, Sharul Saxena, Lisa Cannada, Amrut Borade, Daniel Horwitz, J. Stewart Buck, Michael Bosse, Jerald R. Westberg, Andrew Schmidt, Laurence KemptonEmily Newcomb, Andrew Marcantonio, Matthew Delarosa, Peter Krause, Andrew Gudeman, Brian Mullis, Amro Alhoukail, Ross Leighton, Abigail Cortez, Saam Morshed, Christina Tieszer, David Sanders, Shaan Patel, Hassan R. Mir

Research output: Contribution to journal › Article › peer-review

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.

Original language	English (US)
Pages (from-to)	441-446
Number of pages	6
Journal	Journal of orthopaedic trauma
Volume	34
Issue number	8
DOIs	https://doi.org/10.1097/BOT.0000000000001755
State	Published - Aug 1 2020

All Science Journal Classification (ASJC) codes

Surgery
Orthopedics and Sports Medicine

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Koh, J., Tornetta, P., Walker, B., Jones, C., Sharmaa, T., Sems, S., Ringenbach, K., Boateng, H., Bellevue, K., Firoozabadi, R., Spitler, C., Saxena, S., Cannada, L., Borade, A., Horwitz, D., Buck, J. S., Bosse, M., Westberg, J. R., Schmidt, A., ... Mir, H. R. (2020). What is the real rate of radial nerve injury after humeral nonunion surgery? Journal of orthopaedic trauma, 34(8), 441-446. https://doi.org/10.1097/BOT.0000000000001755

Koh, Justin ; Tornetta, Paul ; Walker, Brock ; Jones, Clifford ; Sharmaa, Tayseer ; Sems, Stephen ; Ringenbach, Kathleen ; Boateng, Henry ; Bellevue, Kate ; Firoozabadi, Reza ; Spitler, Clay ; Saxena, Sharul ; Cannada, Lisa ; Borade, Amrut ; Horwitz, Daniel ; Buck, J. Stewart ; Bosse, Michael ; Westberg, Jerald R. ; Schmidt, Andrew ; Kempton, Laurence ; Newcomb, Emily ; Marcantonio, Andrew ; Delarosa, Matthew ; Krause, Peter ; Gudeman, Andrew ; Mullis, Brian ; Alhoukail, Amro ; Leighton, Ross ; Cortez, Abigail ; Morshed, Saam ; Tieszer, Christina ; Sanders, David ; Patel, Shaan ; Mir, Hassan R. / What is the real rate of radial nerve injury after humeral nonunion surgery?. In: Journal of orthopaedic trauma. 2020 ; Vol. 34, No. 8. pp. 441-446.

@article{0cec63c75d384d269331e0ec3e9360bc,

title = "What is the real rate of radial nerve injury after humeral nonunion surgery?",

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.",

author = "Justin Koh and Paul Tornetta and Brock Walker and Clifford Jones and Tayseer Sharmaa and Stephen Sems and Kathleen Ringenbach and Henry Boateng and Kate Bellevue and Reza Firoozabadi and Clay Spitler and Sharul Saxena and Lisa Cannada and Amrut Borade and Daniel Horwitz and Buck, {J. Stewart} and Michael Bosse and Westberg, {Jerald R.} and Andrew Schmidt and Laurence Kempton and Emily Newcomb and Andrew Marcantonio and Matthew Delarosa and Peter Krause and Andrew Gudeman and Brian Mullis and Amro Alhoukail and Ross Leighton and Abigail Cortez and Saam Morshed and Christina Tieszer and David Sanders and Shaan Patel and Mir, {Hassan R.}",

note = "Funding Information: P. Tornetta has intellectual property with Smith & Nephew and publishing agreement with Wolters-Kluwers. C. B. Jones receives royalties from Lippincott and speaking royalties from Stryker Educational, with grants from DOD METRC and NIH FAITH. A. Marcantonio receives honorarium from AO North America. C. Spitler receives honorarium from AO North America, research support from Depuy-Synthes and serves on the OTA Evidence-Based Quality Value and Safety Committee and AAOS Orthopedic Knowledge Update Committee. L. Cannada receives research support from the Foundation for Orthopedic Trauma and is a board member for the AAOS, Mid America Orthopaedic Association, and the OTA. D. Horwitz is a design consultant for Zimmer Biomet and NewClip and receives research/fellow support from DePuy Synthes. He is a chair on the OTA fund development committee and the AAOS trauma content committee and is president of the FOT. R. Firoozabadi receives consulting support from Smith & Nephew and royalties from Innomed, and an honorarium from AO North America. B. Mullis receives speaking and consulting support from Zimmer Biomet and Smith & Nephew. D. Sanders receives consulting support from Smith & Nephew and Stryker. S. A. Sems receives royalties from Zimmer Biomet. M. Bosse holds stock in Orthopaedic implant companies. H. Boateng receives consulting support from DePuy Synthes. The remaining authors report no conflict of interest.",

year = "2020",

month = aug,

day = "1",

doi = "10.1097/BOT.0000000000001755",

language = "English (US)",

volume = "34",

pages = "441--446",

journal = "Journal of Orthopaedic Trauma",

issn = "0890-5339",

publisher = "Lippincott Williams and Wilkins",

number = "8",

}

Koh, J, Tornetta, P, Walker, B, Jones, C, Sharmaa, T, Sems, S, Ringenbach, K, Boateng, H, Bellevue, K, Firoozabadi, R, Spitler, C, Saxena, S, Cannada, L, Borade, A, Horwitz, D, Buck, JS, Bosse, M, Westberg, JR, Schmidt, A, Kempton, L, Newcomb, E, Marcantonio, A, Delarosa, M, Krause, P, Gudeman, A, Mullis, B, Alhoukail, A, Leighton, R, Cortez, A, Morshed, S, Tieszer, C, Sanders, D, Patel, S & Mir, HR 2020, 'What is the real rate of radial nerve injury after humeral nonunion surgery?', Journal of orthopaedic trauma, vol. 34, no. 8, pp. 441-446. https://doi.org/10.1097/BOT.0000000000001755

What is the real rate of radial nerve injury after humeral nonunion surgery? / Koh, Justin; Tornetta, Paul; Walker, Brock; Jones, Clifford; Sharmaa, Tayseer; Sems, Stephen; Ringenbach, Kathleen; Boateng, Henry; Bellevue, Kate; Firoozabadi, Reza; Spitler, Clay; Saxena, Sharul; Cannada, Lisa; Borade, Amrut; Horwitz, Daniel; Buck, J. Stewart; Bosse, Michael; Westberg, Jerald R.; Schmidt, Andrew; Kempton, Laurence; Newcomb, Emily; Marcantonio, Andrew; Delarosa, Matthew; Krause, Peter; Gudeman, Andrew; Mullis, Brian; Alhoukail, Amro; Leighton, Ross; Cortez, Abigail; Morshed, Saam; Tieszer, Christina; Sanders, David; Patel, Shaan; Mir, Hassan R.