Vitis Finivera Syafitriningrum

20080310043



Peripheral Nerve
Injury
Peripheral nerves is consist
of :
- somatic nervous system
(efferent (motor) and
afferent (sensory) pathway
- autonom nervous system

Nerves can be injured by
ischaemia, compression,
traction, laceration or
burning.
Seddon & Sunderland Classification of
Nerve Injury
Humerus Shaft Fracture
Mechanism of injury
A fall on the hand may twist
the humerus, causing a spiral
fracture.

A fall on the elbow with the
arm abducted exerts a bending
force, resulting in an oblique or
transverse fracture.

A direct blow to the arm causes
a fracture which is either
transverse or comminuted.
Non Operative
Analgesic
Reduction and immobilization
The wrist and finger exercised
The pendulum exercise of humerus

Radial Nerve
Radial Nerve Injury
Low lesions
Caused by fractures or dislocations at the elbow, or to a local wound.
Iatrogenic lesions of the posterior interosseous nerve where it winds through the supinator muscle are
sometimes seen after operations on the proximal end of the radius.
Complains : clumsiness
Test : wrist extension (+) , cannot extend the metacarpophalangeal joints of the hand, weakness of
extension and retroposition of the thumb.

High lesions
occur with fractures of the humerus or after prolonged tourniquet pressure.
Obvious wrist drop, due to weakness of the radial extensors of the wrist, inability to extend the
metacarpophalangeal joints or elevate the thumb.
Sensory loss in snuffbox area

Very high lesions
caused by trauma or operations around the shoulder, chronic compression in axilla
Ex : Saturday Night Palsy in drink and drug addicts or in thin elderly patients using crutches (crutch
palsy).
weakness of the wrist and hand, the triceps is paralysed and the triceps reflex is absent.
A radial nerve injury is the most common peripheral nerve
injury associated with fracture shaft of humerus.
Injuries to the radial nerve can result in significant motor
impairment of the arm and the wrist.

I ntroduction
To find out the incidence of radial nerve palsy in case of
fracture shaft of humerus.
To analyze results of various modalities of treatment of
fracture shaft of humerus associated with radial nerve
injury
To establish a probable guideline for the treatment of
radial nerve injuries in fracture of the shaft of humerus.

Objective
Prospective Study
DESIGN
Place &
Period

Government Wenlock Hospital, K.M.C. and
associated Hospitals, Mangalore
from January 2004 to September 2006.
Population
and Sample
Population : 80 patients of # shaft of humerus
Sample : 25 patients of # shaft of humerus
with radial nerve palsy
Total : 25 20 : immediate nerve palsy
5 : secondary nerve palsy
Methods
Sex predilection ( Female : 36% and Male : 64%)
Side predilection (Right side : Left side = 12:13)
Regarding the relationship between
- Recovery and age group
- Recovery and sex majority
- Recovery and mode of injury
- Recovery and time of exploration of nerve
- Recovery and level of fracture Statistically
significant

Result
Statistically
insignificant
Radial nerve palsy was more commonly seen
in fractures involving the middle third of
Humeral shaft P(0.004).
The incidence of radial nerve palsy was
highest in patients with oblique fracture and
average time of recovery was 22 weeks.
All the cases that were explored showed the
nerve to be in continuity and no surgical repair
of the radial nerve was required P( 0.831).
Result

The outcome of radial nerve palsy was not found
to be related to age group, sex, side, mechanism
of injury, intra-operative condition of nerve,
method of treatment of fracture and time of
exploration of radial nerve.
Conclusion