Wide resection of traction induced radial nerve injury with cable grafting leads to full recovery.
The specific clinical setting of high-energy open humerus fractures combined with radial nerve transection has typically led to poor final outcomes with respect to recovery of nerve function. Attention has focused on the issue of an expanded zone of nerve injury induced by longitudinal traction. The fundamental principle of nerve grafting is to bypass the zone of injury. If direct repair or short nerve grafts are placed within the zone of injury, limited recovery should be expected, and this is exactly what has been documented. Wide resection of the zone of traction induced injury, particularly from the distal injured nerve trunk and replacement with long cable grafts has the potential for improved outcomes. Complete nerve recovery to 5/5 manual motor power testing and bilaterally equivalent grip strength is reported in two initial cases treated according to the wide resection plan.
Henry
Mark
M
Department of Orthopaedic Surgery, Hand and Wrist Center of Houston, 1200 Binz Street, Suite 1200, Houston, TX, 77004, USA. henrypatient@houstonhand.com.
J Neurosurg Sci. 1998 Jun;42(2):79-83
9826791
Chir Organi Mov. 1998 Oct-Dec;83(4):435-40
10369026
J Hand Surg Am. 2004 Jan;29(1):144-7
14751118
Microsurgery. 1996;17(8):431-7
9393662
Microsurgery. 2005;25(5):396-402
16032723
Surg Neurol. 1992 Jun;37(6):425-31
1595047
J Hand Surg Br. 1993 Jun;18(3):320-2
8393905