TY - JOUR
T1 - What is the real rate of radial nerve injury after humeral nonunion surgery?
AU - Koh, Justin
AU - Tornetta, Paul
AU - Walker, Brock
AU - Jones, Clifford
AU - Sharmaa, Tayseer
AU - Sems, Stephen
AU - Ringenbach, Kathleen
AU - Boateng, Henry
AU - Bellevue, Kate
AU - Firoozabadi, Reza
AU - Spitler, Clay
AU - Saxena, Sharul
AU - Cannada, Lisa
AU - Borade, Amrut
AU - Horwitz, Daniel
AU - Buck, J. Stewart
AU - Bosse, Michael
AU - Westberg, Jerald R.
AU - Schmidt, Andrew
AU - Kempton, Laurence
AU - Newcomb, Emily
AU - Marcantonio, Andrew
AU - Delarosa, Matthew
AU - Krause, Peter
AU - Gudeman, Andrew
AU - Mullis, Brian
AU - Alhoukail, Amro
AU - Leighton, Ross
AU - Cortez, Abigail
AU - Morshed, Saam
AU - Tieszer, Christina
AU - Sanders, David
AU - Patel, Shaan
AU - Mir, Hassan R.
N1 - 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.
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85088490615&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85088490615&partnerID=8YFLogxK
U2 - 10.1097/BOT.0000000000001755
DO - 10.1097/BOT.0000000000001755
M3 - Article
C2 - 32569074
AN - SCOPUS:85088490615
VL - 34
SP - 441
EP - 446
JO - Journal of Orthopaedic Trauma
JF - Journal of Orthopaedic Trauma
SN - 0890-5339
IS - 8
ER -