“Natural history of low velocity ballistic nerve injuries to the humerus”

IF 2 3区医学 Q2 ORTHOPEDICS

Archives of Orthopaedic and Trauma Surgery Pub Date : 2025-04-09 DOI:10.1007/s00402-025-05840-w

Nainisha Chintalapudi, Brianna R. Fram, Rachel B. Seymour, Ziqing Yu, Madhav A. Karunakar, Evidence-Based Musculoskeletal Injury, Trauma (EMIT) Collaborative

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引用次数: 0

Abstract

Objectives

To assess ballistic humerus fractures with nerve injuries, their associated characteristics, and functional recovery.

Design

Retrospective review

Setting

Level 1 trauma center over 10-year period.

Patients

143 patients presenting with low-velocity ballistic humerus fractures.

Intervention

Operative intervention and clinical examination of nerve function.

Main outcome measurements

Nerve injury incidence and recovery.

Results

The overall incidence of nerve injury was 21% (30 injuries/143 fractures) with 66.7% of fractures treated operatively. Nerve injury varied based on anatomic region: 28.6% (12/42) distal humerus; 20% (15/75) shaft and, 11.5% (3/26) proximal humerus. Arterial injury (p = 0.011) and bone loss (p = 0.0001) were significantly associated with nerve injury. The nerve was visualized during index surgery in 15 patients, with 4 transections. Multiple nerve injuries (n = 6) were most common around the distal humerus: 41.7% (5/12). The radial nerve comprised 52.9% (n = 9) of injuries in the distal humerus and 62.5% (n = 10) in the shaft with spontaneous recovery occurring in 75% (6/8) with distal fractures and 66.7% (6/9) with shaft fractures. The ulnar nerve accounted for 35.3% (n = 6) of injuries in the distal humerus and 25% (n = 4) in the shaft. Spontaneous recovery occurred in 60% (3/5) of ulnar nerve injuries around distal fractures but in only 25% (1/4) in the shaft. Half of ulnar nerve injuries were associated with additional nerve or vascular injury. The median nerve was the least likely to be injured: 40% (n = 2) distal humerus, 40% (n = 2) shaft, and 20% (n = 1) proximal humerus and 40% (2/5) spontaneously recovered.

Conclusion

In the setting of ballistic humerus fractures, arterial injury and bone loss were significantly associated with nerve injury. Multiple nerve injury occurred most commonly at the distal humerus. There was a 60–75% recovery rate of most nerve injuries however, ulnar nerve injuries around the shaft and median nerve injuries had lower rates of recovery.

Level of evidence

Level III.

查看原文本刊更多论文

"肱骨低速弹道神经损伤的自然史"

目的评价肱骨弹道骨折伴神经损伤及其相关特征和功能恢复情况。设计：1级创伤中心，随访10年。143例患者表现为低速弹道肱骨骨折。介入：神经功能的手术干预及临床检查。主要观察指标：神经损伤发生率及恢复情况。结果神经损伤发生率为21%（30例/143例），手术治疗率为66.7%。神经损伤因解剖区域而异：肱骨远端28.6% (12/42)；20%（15/75）轴，11.5%（3/26）肱骨近端。动脉损伤（p = 0.011）和骨质流失（p = 0.0001）与神经损伤显著相关。15例患者在食指手术中观察到神经，其中4例发生横断。多发神经损伤（n = 6）以肱骨远端周围最常见，占41.7%（5/12）。桡神经在肱骨远端损伤中占52.9% (n = 9)，在肱骨干损伤中占62.5% (n = 10)，在肱骨远端骨折中占75%(6/8)，在肱骨干骨折中占66.7%（6/9）。尺神经在肱骨远端损伤中占35.3% (n = 6)，在肱骨干损伤中占25% （n = 4）。60%（3/5）的尺神经远端骨折周围损伤可自发恢复，但仅25%（1/4）的尺神经轴骨折周围损伤可自发恢复。一半的尺神经损伤伴有额外的神经或血管损伤。中间神经最不容易损伤：40% （n = 2）肱骨远端，40% （n = 2）肱骨干，20% （n = 1）肱骨近端，40%（2/5）自行恢复。结论在肱骨弹道骨折中，动脉损伤和骨丢失与神经损伤有显著相关性。多发神经损伤最常见于肱骨远端。大多数神经损伤的恢复率为60-75%，但尺神经损伤和正中神经损伤的恢复率较低。证据等级：III级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archives of Orthopaedic and Trauma Surgery 医学-外科

CiteScore

4.30

自引率

13.00%

发文量

424

审稿时长

2 months

期刊介绍： "Archives of Orthopaedic and Trauma Surgery" is a rich source of instruction and information for physicians in clinical practice and research in the extensive field of orthopaedics and traumatology. The journal publishes papers that deal with diseases and injuries of the musculoskeletal system from all fields and aspects of medicine. The journal is particularly interested in papers that satisfy the information needs of orthopaedic clinicians and practitioners. The journal places special emphasis on clinical relevance. "Archives of Orthopaedic and Trauma Surgery" is the official journal of the German Speaking Arthroscopy Association (AGA).