title: Avoiding iatrogenic radial nerve injury during humeral fracture surgery: a modified approach to the distal humerus.
abstract: OBJECTIVE
  Our aim was to assess the results of posterior retraction technique to prevent iatrogenic radial nerve injury during humeral fracture surgery.
  
  
  METHODS
  Seventy-two patients who underwent surgery for a distal humerus fracture between 1996 and 2002 were reviewed. These 72 patients comprised Group 1. Following a cadaveric study on the vascularization of the radial nerve, a modified surgical approach was undertaken starting in 2002. Sixty-one patients who underwent this new surgical approach were included in Group 2. The rates of radial nerve deficit of the groups were compared using the Pearson chi-square test.
  
  
  RESULTS
  In Group 1, 19 iatrogenic nerve deficits occurred. After defining the blood circulation of the nerve, the lateral approach was modified. The anterolateral side of the nerve was released and the nerve was left attached to the triceps muscle. In Group 2, one patient developed postoperative transient nerve deficit.
  
  
  CONCLUSIONS
  The radial nerve is supplied by the branches of the deep brachial artery in close relation with the triceps muscle. Anterior dissection and posterior retraction of the radial nerve during lateral approach may preserve its blood supply and reduces the risk of iatrogenic injury.
authors.affiliation: Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Turkey.
authors.forename: Ahmet Ozgür
authors.initials: AO
authors.lastname: Yildirim
authors.forename: Ozdamar Fuad
authors.initials: OF
authors.lastname: Oken
authors.forename: Vuslat Sema
authors.initials: VS
authors.lastname: Unal
authors.forename: Ali Firat
authors.initials: AF
authors.lastname: Esmer
authors.forename: Murat
authors.initials: M
authors.lastname: Gülçek
authors.forename: Ahmet
authors.initials: A
authors.lastname: Uçaner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D002102:Cadaver; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D006811:Humerus / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D011826:Radial Nerve / Q000293:injuries / Q000601:surgery*; D020425:Radial Neuropathy / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome