Anterograde Intramedullary Nailing without Bone Grafting for Humeral Shaft Nonunion Associated with Early Exploration of Secondary Radial Nerve Palsy: A Case Report.

IF 3.2 Q2 CLINICAL NEUROLOGY
Dan Viorel Nistor, Răzvan Marian Melinte, Romana von Mengershausen
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Abstract

Background: Humeral shaft fractures are relatively common. Complications associated with this type of fracture and its treatment include nonunion and radial nerve palsy. Plate osteosynthesis with autologous bone grafting is considered the gold standard for treating nonunion. However, bone grafts might not always be necessary in cases of hypertrophic nonunion, and treatment should be tailored to the specific type and characteristics of the nonunion. The treatment of radial nerve palsy is debated, with some favoring expectant management based on the nerve's ability to regenerate, and others preferring early surgical exploration to prevent possible lasting nerve damage.

Methods: We present the case of a 46-year-old male patient with a six-year-old humeral shaft fracture resulting in hypertrophic nonunion. We treated the nonunion with anterograde intramedullary nailing without bone grafting. Postoperatively, the patient developed severe radial nerve palsy. After repeated electrophysiological studies, a decision was made to surgically explore the nerve 10 days after the nonunion surgery. The nerve was subsequently found to be intact and treated with neurolysis.

Results: Bony union was shown at six months after nonunion surgery. Four months after the nonunion surgery, the patient started to show clinical signs of nerve recovery, and at 12 months he achieved nearly full clinical recovery of radial nerve function.

Conclusions: Anterograde intramedullary nailing without autologous bone grafting may be considered an option for treating hypertrophic nonunion. The management of radial nerve palsy requires effective cooperation and communication between patient and physician. Further research is necessary to be able to better predict nerve recovery.

无需植骨的前行髓内钉治疗伴有继发性桡神经麻痹的肱骨轴不连:病例报告。
背景介绍肱骨轴骨折比较常见。与这类骨折及其治疗相关的并发症包括骨折不愈合和桡神经麻痹。钢板骨结合自体骨移植被认为是治疗骨不连的金标准。然而,在肥大性骨折的病例中并不一定需要植骨,治疗方法应根据骨折的具体类型和特征而定。对于桡神经麻痹的治疗方法还存在争议,有些人倾向于根据神经再生能力进行预期治疗,而另一些人则倾向于早期手术探查,以防止可能出现的持久性神经损伤:本病例是一名 46 岁的男性患者,其肱骨轴骨折已有 6 年之久,导致肱骨轴肥大性不愈合。我们采用前向髓内钉治疗,未进行植骨。术后,患者出现了严重的桡神经麻痹。经过反复的电生理研究,我们决定在骨不连手术后 10 天对神经进行手术探查。随后发现神经完好无损,并进行了神经切除术:结果:骨结合显示在骨不连手术后六个月。结果:骨结合在骨不连手术后 6 个月出现,在骨不连手术后 4 个月,患者开始出现神经恢复的临床症状,在 12 个月时,他的桡神经功能几乎完全恢复:结论:不进行自体骨移植的前行髓内钉可作为治疗肥大性桡神经离断的一种选择。桡神经麻痹的治疗需要患者和医生之间的有效合作与沟通。为了更好地预测神经恢复情况,有必要开展进一步研究。
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来源期刊
Neurology International
Neurology International CLINICAL NEUROLOGY-
CiteScore
3.70
自引率
3.30%
发文量
69
审稿时长
11 weeks
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