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

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.

Introduction
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.

Objective
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.

Methods
DESIGN

Prospective Study

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

Result
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
Statistically
insignificant
- Recovery and mode of injury
- Recovery and time of exploration of nerve
- Recovery and level of fracture Statistically
significant

Result
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).

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