Vitis Finivera Syafitriningrum20080310043

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 InjuryLow 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.

Introduction

• 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 StudyDESIGN

Place & Place & Period 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 humerusSample : 25 patients of # shaft of humerus with radial nerve palsyTotal : 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

• 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