1
|
Hurley ET, Wickman J, Crook BS, Cabell G, Rodriguez K, Boadi P, DeBaun MR, Pean C, Klifto C. Intramedullary nailing vs. open reduction-internal fixation for humeral shaft fractures: a meta-analysis of randomized controlled trials. J Shoulder Elbow Surg 2023; 32:2567-2574. [PMID: 37579941 DOI: 10.1016/j.jse.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND The purpose of this study was to perform a meta-analysis of randomized controlled trials (RCTs) to compare outcomes following intramedullary nailing (IMN) vs. open reduction-internal fixation (ORIF) for humeral shaft fractures. METHODS A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RCTs comparing IMN and ORIF for humeral shaft fractures were included. Clinical outcomes were compared using RevMan. P < .05 was considered statistically significant. RESULTS Ten RCTs with 512 patients were included. Overall, 8.4% of patients treated with IMN and 6.4% of patients treated with ORIF had nonunion (P = .57, I2 = 0%), with a significantly faster time to union with IMN (10 weeks vs. 11.9 weeks, P < .05). There was no significant difference in the rate of reoperation (11.6% in IMN group vs. 7.6% in ORIF group, P = .26) or radial nerve palsy (2.8% in IMN group vs. 4.2% in ORIF group, P = .58). A lower rate of infection was noted with IMN (1.2% vs. 5.3%, P < .05). Additionally, there was a lower operative time with IMN (61 minutes vs. 88 minutes, P < .05). CONCLUSIONS The Level I evidence in the literature does not show a significant difference in rates of union, reoperation, or radial nerve palsy between IMN and ORIF for humeral shaft fractures. Overall, treatment with IMN results in a lower infection rate, less operative time, and a modestly quicker time to union. The optimal treatment strategy for humeral shaft fractures may be best informed by fracture pattern and surgeon preference.
Collapse
Affiliation(s)
- Eoghan T Hurley
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA.
| | - John Wickman
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Bryan S Crook
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Grant Cabell
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Kaitlyn Rodriguez
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Prince Boadi
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Malcolm R DeBaun
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christian Pean
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Christopher Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
2
|
Greiner F, Kaiser G, Kleiner A, Brugger J, Aldrian S, Windhager R, Hajdu S, Schreiner M. Distal locking technique affects the rate of iatrogenic radial nerve palsy in intramedullary nailing of humeral shaft fractures. Arch Orthop Trauma Surg 2023; 143:4117-4123. [PMID: 36316427 PMCID: PMC10293438 DOI: 10.1007/s00402-022-04665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/12/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intramedullary humeral nailing is a common and reliable procedure for the treatment of humeral shaft fractures. Radial nerve palsy is a common complication encountered in the treatment of this pathology. The radial nerve runs from posterior to anterior at the lateral aspect of the distal humerus. Hence, there is reason to believe that due to the anatomic vicinity of the radial nerve in this area, lateral-medial distal locking in intramedullary nailing of the humerus may be associated with a greater risk for iatrogenic radial nerve injury compared to anterior-posterior locking. QUESTIONS/PURPOSE To assess whether the choice of distal locking (lateral-medial versus anterior-posterior distal locking) in intramedullary humeral nailing of humeral shaft fractures affects the risk for iatrogenic radial nerve injury. PATIENTS AND METHODS Overall, 203 patients (116 females, mean age 64.3 ± 18.6 years), who underwent intramedullary nailing of the humerus between 2000 and 2020 at a single level-one trauma center, met the inclusion criteria and were analyzed in this retrospective case-control study. Patients were subdivided into two groups according to the distal locking technique. RESULTS Anterior-posterior locking was performed in 176 patients versus lateral-medial locking in 27 patients. We observed four patients with iatrogenic radial nerve palsy in both groups. Risk for iatrogenic radial nerve palsy was almost 7.5 times higher for lateral-medial locking (OR 7.48, p = 0.006). There was no statistically significant difference regarding intraoperative complications, union rates or revision surgeries between both groups. CONCLUSIONS Lateral-medial distal locking in intramedullary nailing of the humerus may be associated with a greater risk for iatrogenic radial nerve palsy than anterior-posterior locking. Hence, we advocate for anterior-posterior locking. LEVEL OF EVIDENCE Level III retrospective comparative study.
Collapse
Affiliation(s)
- Fabian Greiner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Georg Kaiser
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Anne Kleiner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Jonas Brugger
- Center for Medical Statistics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Silke Aldrian
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Markus Schreiner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| |
Collapse
|
3
|
Rasulić L, Đjurašković S, Lakićević N, Lepić M, Savić A, Grujić J, Mićić A, Radojević S, Córdoba-Mosqueda ME, Visani J, Puzović V, Kovačević V, Vitošević F, Mandić-Rajčević S, Knezevic S. Etiological and epidemiological characteristics of surgically treated radial nerve lesions: A 20-year single-center experience. Front Surg 2022; 9:942755. [PMID: 36204344 PMCID: PMC9530258 DOI: 10.3389/fsurg.2022.942755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionRadial nerve lesions present a clinical entity that may lead to disability, psychological distress, and job loss, and thus requires great attention. Knowledge of the etiology and exact mechanism of the nerve impairment is of great importance for appropriate management of these patients, and there are only a few papers that focused on these features in patients with surgically treated radial nerve lesions. The lack of studies presenting the etiology and injury mechanisms of surgically treated radial nerve lesions may be due to a relatively small number of specialized referral centers, dispersion to low-flow centers, and a greater focus on the surgical treatment outcomes.AimThe aim of this study was to describe the etiological and epidemiological characteristics of patients with surgically treated radial nerve lesions of various origins.MethodsThis retrospective study evaluated 147 consecutive patients with radial nerve lesion, treated in the department during the last 20 years, from January 1, 2001, until December 31, 2020.ResultsThe majority of patients belonged to the working population, and 70.1% of them were male. Most commonly, the etiology of nerve lesion was trauma (63.3%) or iatrogenic injury (28.6%), while the less common origin was idiopathic (4.1%) or neoplastic (4.1%). The most frequent location of the lesion was in the upper arm, followed by the elbow and forearm. Fracture-related contusion was the most common mechanism (29.9%), followed by postoperative fibrosis (17.7%), lacerations (17.7%), and compression (15.6%).ConclusionBased on the fact that traumatic or iatrogenic injuries constitute the majority of cases, with their relevant mechanisms and upper arm predomination, it is crucial to raise awareness and understanding of the radial nerve injuries among orthopedic surgeons to decrease the numbers of these patients and properly preserve or treat them within the initial surgery.
Collapse
Affiliation(s)
- Lukas Rasulić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
- Correspondence: Lukas Rasulić
| | - Slavko Đjurašković
- Clinic for Neurosurgery, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Novak Lakićević
- Clinic for Neurosurgery, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Milan Lepić
- Clinic for Neurosurgery, Military Medical Academy, Belgrade, Serbia
| | - Andrija Savić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jovan Grujić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Peripheral Nerve Surgery, Functional Neurosurgery and Pain Management Surgery, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksa Mićić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Jacopo Visani
- Department of Neurosurgery, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | | | - Vojin Kovačević
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic for Neurosurgery, Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Filip Vitošević
- Interventional Neuroradiology Department, Center for Radiology and MRI, Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- School of Public Health and Health Management and Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Saša Knezevic
- Center for Anesthesiology, Resuscitation and Pain Therapy, University Clinical Centre of Serbia, Belgrade, Serbia
| |
Collapse
|
4
|
Li W, Li H, Wang H, Wang S. Ultrasound-guided preoperative localization of radial nerve in the treatment of extra-articular distal humeral shaft fractures. BMC Musculoskelet Disord 2022; 23:1. [PMID: 34980067 PMCID: PMC8725401 DOI: 10.1186/s12891-021-04954-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/08/2021] [Indexed: 01/13/2023] Open
Abstract
Background The aim of this study was to discuss the treatment of extra-articular distal humeral shaft fractures using ultrasound-guided preoperative localization of radial nerve. Methods Between May 2010 and December 2019, 56 patients with extra-articular distal humeral shaft fractures were retrospectively reviewed. Twenty eight patients were received examination by using preoperative localization of radial nerve guided by ultrasound-guided preoperative localization (group A) and 28 control patients without ultrasound-guided (group B). All patients were treated surgically for distal humeral shaft fractures by posterior approach techniques. Operative time, radial nerve exposure time, intraoperative bleeding volume, union time and iatrogenic radial nerve palsy rate were compared between the two groups. Elbow function was also evaluated using the Mayo Elbow Performance Score (MEPS). Results A significant difference was observed between the two groups, Operative time (113.25 min vs 135.86 min) (P < 0.001), radial nerve exposure time (20.82 min vs 32.53 min) (P < 0.001), intraoperative bleeding volume (246.80 ml vs 335.52 ml) (P < 0.001). However, iatrogenic radial nerve palsy rate (3.6% vs 7.1%) (P = 0.129), the fracture union time (13.52 months vs 12.96 months) (P = 0.796) and the MEPS score (87.56 vs 86.38) (P = 0.594) were no significantly different in both groups. Conclusions The study demonstrates that ultrasound-guided preoperative localization is an effective approach in the treatment of extra-articular distal humeral shaft fracture by revealing radial nerve, which may help reduce the operative time, radial nerve exposure time and the intraoperative bleeding volume.
Collapse
Affiliation(s)
- Weifeng Li
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320, Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Hui Li
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320, Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Haiying Wang
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320, Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Shunyi Wang
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320, Changcheng Street, Baoding, 071000, Hebei, People's Republic of China.
| |
Collapse
|
5
|
Rubio DA, Pacheco A, Abrilla A. Measurement of the Radial Nerve Danger Zone in Filipino Adults: A Cadaveric Study. Malays Orthop J 2021; 15:45-51. [PMID: 34966494 PMCID: PMC8667237 DOI: 10.5704/moj.2111.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/16/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction The radial nerve danger zone (RNDZ) is an important anatomic consideration to anticipate or prevent injury in trauma assessment or surgical fixation. No published estimate currently exists for Filipinos. In this study, we sought to provide a local estimate and explore potential predictors of this anatomic region in Filipino adult cadavers. Materials and methods Posterior dissection to expose and measure the radial nerve, from the lateral epicondyle to the lateral intermuscular septum, was performed in 60 upper limbs from 30 formalin-preserved cadavers in the laboratory of the Department of Anatomy, College of Medicine, University of the Philippines Manila. Univariate and multivariate linear regression modelling was performed with RNDZ as the dependent variable and age, sex, height and humeral length as potential independent variables individually and in combinations. Results The mean radial nerve length from the lateral epicondyle to the lateral intermuscular septum was estimated at 10.6 cm (95% confidence interval: 10.3 cm, 10.9cm). Height and humeral length were statistically significant univariate predictors in female cadavers, while only height was significant in male cadavers. In addition, all multivariate regression models were statistically significant and accounted for more than 57% of the variability in female RNDZ estimates. In comparison, only models that included height and age were statistically significant predictors of RNDZ and accounted for at most 22% of the variability of the estimate in males. Conclusion The estimated length of the radial nerve danger zone generated in this study should be strongly considered over other published estimates in surgical fixation procedures performed in adult Filipinos.
Collapse
Affiliation(s)
- D A Rubio
- Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - A Pacheco
- Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - A Abrilla
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| |
Collapse
|
6
|
Saaiq M. Presentation and Management Outcome of High Radial Nerve Palsy with Tendon Transfers. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:578-584. [PMID: 34692942 DOI: 10.22038/abjs.2020.51938.2563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/30/2020] [Indexed: 11/06/2022]
Abstract
Background This randomized clinical trial was carried out to document the clinical presentation of isolated high radial nerve palsy (high RNP) and compare the outcome of triple tendon transfers. Methods The study included patients of all genders and ages who presented with isolated high RNP. Half of them were randomly assigned to the flexor carpi radialis set (FCR-set) of tendon transfers (group A) and a half to the flexor carpi ulnaris (FCU-set) of tendon transfers (group B). Results Out of 44 patients, 38 were males, and 6 were females. The age ranged from 7 years to 55 years. 26(59.09%) patients had primary RNP in association with fractures of the humerus. The postoperative mean disability of arm, shoulder, and hand score (Quick DASH-11 score) for the patients in the FCR-set of transfers was 34.54%% versus 41.81% for the FCU-set of transfers. 11 patients (25%) developed radial deviation deformity. Conclusion RNP was predominantly found among males of the young age group, and the majority of the cases resulted from preventable causes. The triple tendon transfers among patients of the two groups robustly restored the lost extension of the wrist and digits in a matching way. The patients also subjectively reported remarkable improvement in terms of the favorable Quick-DASH-11 scores. Radial deviation deformity occurred among half of the patients who underwent the FCU set of tendon transfers.
Collapse
Affiliation(s)
- Muhammad Saaiq
- Consultant Plastic surgeon and Head of Plastic Surgery Department, National Institute of Rehabilitation Medicine (NIRM), Islamabad, Pakistan
| |
Collapse
|
7
|
Yeh KL, Liaw CK, Wu TY, Chen CP. Radial nerve recovery following closed nailing of humeral shaft fractures without radial nerve exploration: A retrospective study. World J Clin Cases 2021; 9:8044-8050. [PMID: 34621861 PMCID: PMC8462186 DOI: 10.12998/wjcc.v9.i27.8044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/08/2021] [Accepted: 08/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Radial nerve palsy due to humeral shaft fracture is the most common peripheral nerve injury associated with long bone fractures. An antegrade nailing surgical technique is becoming popular for the fixation of these fractures with minimal invasiveness. We analyzed nerve recovery in patients with humeral shaft fracture and radial nerve palsy treated with humeral nail fixation without nerve exploration.
AIM To assess the radial nerve recovery rate and time from humeral shaft fracture with surgical treatment using close nailing.
METHODS We retrospectively collected data of patients who underwent undergone surgical nail fixation for humeral shaft fractures between October 1, 2016, and March 31, 2020. Subsequently, we analyzed the primary or secondary radial nerve palsy recovery rate and radial nerve motor function recovery time.
RESULTS The study included 70 patients who underwent surgical treatment for closed- or Gustilo type I open humeral shaft fractures using a nail fixation technique without radial nerve exploration. The patients suffered from primary (n = 5) and secondary (n = 5) radial nerve palsy. A 100% radial nerve recovery rate was achieved. The mean recovery time was 4.3 mo.
CONCLUSION The study results indicate full recovery of radial nerve palsies from humeral shaft fracture using close nailing treatment. Surgeons need not be concerned about the occurrence of permanent nerve palsies.
Collapse
Affiliation(s)
- Kuei-Lin Yeh
- Department of Orthopedics, Shin Kong Wu-Ho Su Memorial Hospital, Taipei City 111, Taiwan
| | - Chen-Kun Liaw
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 11031, Taiwan
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering; Research Center of Biomedical Device, Taipei Medical University, Taipei City 11301, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Zhongxing Branch, Taipei City Hospital, Taipei City 10341, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei City 10055, Taiwan
- National Taipei University of Nursing and Health Science, Taipei City 11219, Taiwan
| | - Chung-Pei Chen
- Department of Orthopedics, Cathay General Hospital, New Taipei City 221, Taiwan
| |
Collapse
|
8
|
MacKay BJ, Cox CT, Valerio IL, Greenberg JA, Buncke GM, Evans PJ, Mercer DM, McKee DM, Ducic I. Evidence-Based Approach to Timing of Nerve Surgery: A Review. Ann Plast Surg 2021; 87:e1-e21. [PMID: 33833177 PMCID: PMC8560160 DOI: 10.1097/sap.0000000000002767] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 01/08/2023]
Abstract
ABSTRACT Events causing acute stress to the health care system, such as the COVID-19 pandemic, place clinical decisions under increased scrutiny. The priority and timing of surgical procedures are critically evaluated under these conditions, yet the optimal timing of procedures is a key consideration in any clinical setting. There is currently no single article consolidating a large body of current evidence on timing of nerve surgery. MEDLINE and EMBASE databases were systematically reviewed for clinical data on nerve repair and reconstruction to define the current understanding of timing and other factors affecting outcomes. Special attention was given to sensory, mixed/motor, nerve compression syndromes, and nerve pain. The data presented in this review may assist surgeons in making sound, evidence-based clinical decisions regarding timing of nerve surgery.
Collapse
Affiliation(s)
- Brendan J. MacKay
- From the Texas Tech University Health Sciences Center
- University Medical Center, Lubbock, TX
| | | | - Ian L. Valerio
- Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | - Peter J. Evans
- Orthopaedic Surgery, Cleveland Clinic of Florida, Weston, FL
| | - Deana M. Mercer
- Department of Orthopaedics and Rehabilitation, The University of New Mexico, Albuquerque, NM
| | - Desirae M. McKee
- From the Texas Tech University Health Sciences Center
- University Medical Center, Lubbock, TX
| | | |
Collapse
|
9
|
Perspectives on 3D Bioprinting of Peripheral Nerve Conduits. Int J Mol Sci 2020; 21:ijms21165792. [PMID: 32806758 PMCID: PMC7461058 DOI: 10.3390/ijms21165792] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/28/2020] [Accepted: 08/10/2020] [Indexed: 12/25/2022] Open
Abstract
The peripheral nervous system controls the functions of sensation, movement and motor coordination of the body. Peripheral nerves can get damaged easily by trauma or neurodegenerative diseases. The injury can cause a devastating effect on the affected individual and his aides. Treatment modalities include anti-inflammatory medications, physiotherapy, surgery, nerve grafting and rehabilitation. 3D bioprinted peripheral nerve conduits serve as nerve grafts to fill the gaps of severed nerve bodies. The application of induced pluripotent stem cells, its derivatives and bioprinting are important techniques that come in handy while making living peripheral nerve conduits. The design of nerve conduits and bioprinting require comprehensive information on neural architecture, type of injury, neural supporting cells, scaffold materials to use, neural growth factors to add and to streamline the mechanical properties of the conduit. This paper gives a perspective on the factors to consider while bioprinting the peripheral nerve conduits.
Collapse
|
10
|
Li Y, Tian Q, Leng K, Guo M. Comparison of the Posterior and Anterolateral Surgical Approaches in the Treatment of Humeral Mid-Shaft Fractures: A Retrospective Study. Med Sci Monit 2020; 26:e924400. [PMID: 32639953 PMCID: PMC7366785 DOI: 10.12659/msm.924400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to retrospectively assess and compare the functional outcomes and complications following anterolateral versus posterior surgical approaches for the treatment of mid-shaft fractures of the humerus. Material/Methods This study included 107 patients treated for mid-shaft fractures between May 2015 and July 2018. Demographic and surgical data were collected for each patient. During follow-up visits, radiographs were acquired and evaluated. The clinical outcomes of the involved joints were assessed by the Constant scoring system, range of motion (ROM), and the Mayo Elbow Performance Scoring system at the 12-month follow-up. Results The posterior approach was performed in 57 patients with type A fractures (group I, n=28) and type B or C fractures (group III, n=29). The anterolateral approach was performed in 50 patients with type A fractures (group II, n=32) and type B or C fractures (group IV, n=18). There were no significant differences between group I and group II nor between group III and group IV with respect to patient demographic data, surgical data, Constant score, ROM, or Mayo Elbow Performance score. A significant difference in the total complication rate was observed between group I and II. Conclusions The anterolateral approach showed an advantage over the posterior approach for treating simple humeral mid-shaft fractures. However, this advantage was not observed in treating comminuted fractures.
Collapse
Affiliation(s)
- Yihan Li
- Orthopedic Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Qingxian Tian
- Orthopedic Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Kungpeng Leng
- Orthopedic Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| | - Meng Guo
- Orthopedic Department, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China (mainland)
| |
Collapse
|
11
|
Vaishya R, Kandel IS, Agarwal AK, Vijay V, Vaish A, Acharya K. Is early exploration of secondary radial nerve injury in patients with humerus shaft fracture justified? J Clin Orthop Trauma 2019; 10:535-540. [PMID: 31061585 PMCID: PMC6494759 DOI: 10.1016/j.jcot.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Radial nerve is commonly injured with a fracture of the shaft of the humerus. Primary radial nerve injury occurs at the time of fracture, and secondary nerve injuries are seen after closed reduction or operative management. Management of these secondary nerve injuries is controversial regarding conservative approach verses early exploration. MATERIALS AND METHODS The PubMed, Science Direct, Scopus, and Google Scholar were used to find out relevant studies in the English language from October 2007 to October 2017. After a search of total 114 articles, we excluded 107 articles which did not meet our inclusion criteria, and only seven studies were thoroughly reviewed. RESULTS Among the seven studies, three studies by Wang JP, Wang X, and Reichert P have included only secondary radial nerve injuries. Studies by Noaman H, Gouse M, Schwab TR and Bhardwaj A have included both primary as well as secondary radial nerve injury cases. Four studies used a conservative strategy and late exploration was advocated only if no nerve recovery was found within three to five months. Three studies recommended early radial nerve exploration (within the first two weeks) in patients with secondary radial nerve injury. CONCLUSIONS The pattern and duration of radial nerve recovery in secondary nerve injury was similar to that seen in primary radial nerve palsy. No advantage was seen in the early exploration of the radial nerve in most of these studies. If there is no misplaced instrumentation, macroscopic laceration of nerve or fracture displacement in the postoperative radiograph, secondary radial nerve injury can be treated as a primary radial nerve injury, and we recommend observation for a minimum of four to five months before exploration.
Collapse
Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India
| | - Ishwar Sharma Kandel
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India
| | - Amit Kumar Agarwal
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India,Corresponding author. Orthopaedic Surgeon, Indraprastha Apollo Hospitals, New Delhi, 110076, India.
| | - Vipul Vijay
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India
| | - Abhishek Vaish
- Department of Orthopaedics, Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, 110076, India
| | - Karuna Acharya
- Department of Emergency, Gandaki Medical College, Pokhara, Nepal
| |
Collapse
|
12
|
Boni R, Ali A, Shavandi A, Clarkson AN. Current and novel polymeric biomaterials for neural tissue engineering. J Biomed Sci 2018; 25:90. [PMID: 30572957 PMCID: PMC6300901 DOI: 10.1186/s12929-018-0491-8] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022] Open
Abstract
The nervous system is a crucial component of the body and damages to this system, either by of injury or disease, can result in serious or potentially lethal consequences. Restoring the damaged nervous system is a great challenge due to the complex physiology system and limited regenerative capacity.Polymers, either synthetic or natural in origin, have been extensively evaluated as a solution for restoring functions in damaged neural tissues. Polymers offer a wide range of versatility, in particular regarding shape and mechanical characteristics, and their biocompatibility is unmatched by other biomaterials, such as metals and ceramics. Several studies have shown that polymers can be shaped into suitable support structures, including nerve conduits, scaffolds, and electrospun matrices, capable of improving the regeneration of damaged neural tissues. In general, natural polymers offer the advantage of better biocompatibility and bioactivity, while synthetic or non-natural polymers have better mechanical properties and structural stability. Often, combinations of the two allow for the development of polymeric conduits able to mimic the native physiological environment of healthy neural tissues and, consequently, regulate cell behaviour and support the regeneration of injured nervous tissues.Currently, most of neural tissue engineering applications are in pre-clinical study, in particular for use in the central nervous system, however collagen polymer conduits aimed at regeneration of peripheral nerves have already been successfully tested in clinical trials.This review highlights different types of natural and synthetic polymers used in neural tissue engineering and their advantages and disadvantages for neural regeneration.
Collapse
Affiliation(s)
- Rossana Boni
- Bioengineering Research Team, Centre for Bioengineering and Nanomedicine, Department of Food Science, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Azam Ali
- Bioengineering Research Team, Centre for Bioengineering and Nanomedicine, Department of Food Science, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Amin Shavandi
- Bioengineering Research Team, Centre for Bioengineering and Nanomedicine, Department of Food Science, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
- BioMatter-Biomass Transformation Lab (BTL), École interfacultaire de Bioingénieurs (EIB), École polytechnique de Bruxelles, Université Libre de Bruxelles, Avenue F.D. Roosevelt, 50 - CP 165/61, 1050 Brussels, Belgium
| | - Andrew N. Clarkson
- Department of Anatomy, Brain Health Research Centre and Brain Research New Zealand, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| |
Collapse
|
13
|
Laulan J. High radial nerve palsy. HAND SURGERY & REHABILITATION 2018; 38:2-13. [PMID: 30528552 DOI: 10.1016/j.hansur.2018.10.243] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/16/2018] [Accepted: 10/02/2018] [Indexed: 12/30/2022]
Abstract
High radial palsy is primarily associated with humeral shaft fractures, whether primary due to the initial trauma, or secondary to their treatment. The majority will spontaneously recover, therefore early surgical exploration is mainly indicated for open fractures or if ultrasonography shows severe nerve damage. Initial signs of nerve recovery may appear between 2 weeks and 6 months. Otherwise, the decision to explore the nerve is based on the patient's age, clinical examination and electroneuromyography, as well as ultrasonography findings. If recovery does not occur, an autograft is indicated only in younger patients, before 6 months, if local conditions are suitable. Otherwise, nerve transfers performed by an experienced team give satisfactory results and can be offered up to 10 months post-injury. Tendon transfers are the gold standard treatment and the only option available beyond 10 to 12 months. The results are reliable and fast.
Collapse
Affiliation(s)
- J Laulan
- CHRU de Tours, hôpital Trousseau, services d'orthopédie 1 et 2, unité de chirurgie de la main et du membre supérieur, 37044 Tours cedex 9, France.
| |
Collapse
|
14
|
Akhavan-Sigari R, Mielke D, Farhadi A, Rohde V. Study of Radial Nerve Injury Caused By Gunshot Wounds and Explosive Injuries among Iraqi Soldiers. Open Access Maced J Med Sci 2018; 6:1622-1626. [PMID: 30337976 PMCID: PMC6182541 DOI: 10.3889/oamjms.2018.346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 08/29/2018] [Accepted: 08/31/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Gunshot wounds and blast injuries to the upper limbs produce complex wounds requiring management by multiple surgical specialities. AIM We sought to determine the pattern of peripheral nerve injuries among Iraqi soldiers in the war. METHODS We performed a 3 year retrospective cohort analysis based on medical records of patients with sustaining gunshot wounds and blast injuries to the upper limbs. Ethical approval was obtained from the institutional review board. The patients included were male, serving military personnel of all age groups and ranks presenting with weakness or sensory loss of radial nerve. Three hundred eighteen patients aged 24 years or older with a high-energy, diaphyseal fracture of the humerus and complete motor and sensory radial nerve palsy were reviewed retrospectively. In these patients, the physical examination and electrodiagnostic study were carried out by experienced neurologists. Seddon's classification system was used to assess the severity of the injury. The data related to the types of fracture, the type of damage, the factors causing damage and the failure of treatment were entered into the IBM SPSS 23 software after extraction of files. Based on mid-range indicators and data distribution, traumatic injuries among Iraqi soldiers in the war against ISIL were then investigated. RESULTS A group of 318 patients with mean age of 25.41 ± 6 years were enrolled in the study, of which 127 patients were included with an open fracture and 191 patients with closed lesions. All 127 patients with a transected radial nerve had an open humerus fracture and were part of a complex upper-extremity injury. 113 of 127 subjects had primary repair of the radial nerve and recovered well. 14 of 127 subjects were not recovered. 3 of them had iatrogenic radial nerve injury due to the internal fixation device. Furthermore, all 191 patients with closed injuries recovered well. The average time to initial signs of recovery was 8 weeks (range, 1-27 weeks). Axonotmesis and Neurotmesis were found in 283 (89%) subjects. The average time to full recovery was determined to be 6 months (range, 1-22 months). The blast was found to be the main cause of nerve injury in 236 (74.2%) cases, followed by gunshot damage (21.4%, 68 subjects), falling from height and motor vehicle accidents (4.4%, 14 subjects) and multiple injuries (17%, 54 cases). CONCLUSIONS Trauma caused by factors such as explosions and gunshot worsens the condition of the injuries and presents the treatment conditions with many challenges. However, the success rate in post-surgical recovery of humerus fracture and injured radial nerve can be remarkably higher in young people as compared to other age groups.
Collapse
Affiliation(s)
- Reza Akhavan-Sigari
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
- Department of Neurosurgery, Bouali Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - Afshin Farhadi
- Department of Orthopedic Surgery, Tehran Medical Sciences Branch, Islamic Azad University, Bouali Hospital, Tehran, Iran
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
15
|
Yoshida N, Tsuchida Y. Radial nerve palsy due to supracondylar open fracture in a child. BMJ Case Rep 2017; 2017:bcr-2017-222303. [PMID: 29018017 DOI: 10.1136/bcr-2017-222303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Naoki Yoshida
- Department of Orthopedic Trauma Surgery, Shonankamakura General Hospital, Kanagawa, Japan
| | - Yoshihiko Tsuchida
- Department of Orthopedic Trauma Surgery, Shonankamakura General Hospital, Kanagawa, Japan
| |
Collapse
|
16
|
Kulkarni VS, Kulkarni MS, Kulkarni GS, Goyal V, Kulkarni MG. Comparison between antegrade intramedullary nailing (IMN), open reduction plate osteosynthesis (ORPO) and minimally invasive plate osteosynthesis (MIPO) in treatment of humerus diaphyseal fractures. Injury 2017; 48 Suppl 2:S8-S13. [PMID: 28802426 DOI: 10.1016/s0020-1383(17)30487-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The three currently used methods of treatment: namely open reduction plate osteosynthesis (ORPO), Minimally invasive plate osteosynthesis (MIPO), antegrade intramedullary nailing(IMN) are all reported as satisfactory procedures for treatment of humeral shaft fractures. However none of the published reports have a comparison of superiority of one procedure over the other. We evaluated the clinical, radiological and functional outcome of the three procedures. MATERIALS AND METHODS We studied adult patients with humerus shaft fractures over a period of 2 years from May 2014 to May 2016 in a level 1 trauma center. Forty-four were treated with IMN, 34 treated with ORPO, and 34 with MIPO. The null hypothesis tested in this study is that there is no difference between IMN, ORPO, MIPO with respect to union time, surgical time, complication rate, non-union rate and functional outcome. Functional outcome was studied by comparing the UCLA shoulder and MEP scores in the three groups. RESULTS 112 patients were studied consisting of 83 males and 29 females with mean age of 39 years (range 18-70). IMN group showed early union with mean of 12.73 weeks compared to MIPO (14.45 weeks) and ORPO(13.58 weeks), (p<0.05). MIPO had no events of non-union, as compared to ORPO (5 non-unions) and IMN (10 non-unions), (p=0.04). The range of movement at the shoulder with the UCLA score was significantly better with a score of 32.26 in MIPO as compared to 27.54 in IMN and 28.82 in ORPO (p<0.05). The difference in MEPS score in the three groups was not significant (p=0.31). IMN required a mean of 117.95 minutes intraoperatively as compared to 131 and 150.58 mins in MIPO, ORPO respectively. CONCLUSION MIPO is overall better with respect to non-union, functional outcome and complications rate. The surgical time depends on the surgeons' skill and learning curve. Thus considering the advantages and risks involved in the various procedure and surgical acumen, each case should be individualized to have a good outcome. We advocate that MIPO can be safely used as an alternative in treating these fractures.
Collapse
Affiliation(s)
- Vidisha Sunil Kulkarni
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India
| | - Madhura Sujay Kulkarni
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India.
| | - Govind Shivram Kulkarni
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India
| | - Vaibhav Goyal
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India
| | - Milind Govind Kulkarni
- Department of Orthopaedics and Trauma, Swasthiyog Pratishthan Fracture and Orthopaedic Hospital, Miraj 416410, India
| |
Collapse
|
17
|
Diogo CC, Camassa JA, Pereira JE, Costa LMD, Filipe V, Couto PA, Geuna S, Maurício AC, Varejão AS. The use of sheep as a model for studying peripheral nerve regeneration following nerve injury: review of the literature. Neurol Res 2017; 39:926-939. [DOI: 10.1080/01616412.2017.1331873] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Camila Cardoso Diogo
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - José Arthur Camassa
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
| | - José Eduardo Pereira
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Luís Maltez da Costa
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Vítor Filipe
- Department of Engineering, School of Science and Technology, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- INESC TEC, Porto, Portugal
| | - Pedro Alexandre Couto
- Department of Engineering, School of Science and Technology, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CITAB, Centre for the Research and Technology of Agro-Environmental and Biological Sciences, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Torino, Italy
| | - Ana Colette Maurício
- Department of Veterinary Clinics, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto (UP), Porto, Portugal
- Animal Science and Study Centre (CECA), Food and Agrarian Sciences and Technologies Institute (ICETA), University of Porto, Porto, Portugal
| | - Artur Severo Varejão
- Department of Veterinary Sciences, University of Trás-os-Montes e Alto Douro, UTAD, Vila Real, Portugal
- CECAV, Centre for Animal Sciences and Veterinary Studies, University of Trás-os-Montes e Alto Douro, Vila Real, Portugal
| |
Collapse
|