Radial nerve palsy in surgical revision of total elbow arthroplasties: A study of 4 cases and anatomical study, possible aetiologies and prevention.
BACKGROUND
Damage to the radial nerve in the arm during revision of total elbow arthroplasty is a serious complication; which is still not well documented. The aim of this study was to define a way on how to avoid this complication and to prevent it.


METHODS
Four patients underwent radial palsy after revision of total elbow arthroplasty. An anatomical study on 20 upper limbs was performed to define landmarks for the radial nerve in the arm and elbow.


RESULTS
Radial nerve damage occurred near the proximal tip of the stem in all four patients, due to cement seepage caused by cortical effraction in two patients, and to damage caused by the retractors in the two other patients. The anatomical study made it possible to specify landmarks for the radial nerve in relation to the humerus. A high-risk area located 14cm away from the tip of the olecranon fossa, and 15.5cm from the medial epicondyle, was identified.


CONCLUSIONS
A high-risk area for the radial nerve was defined and suggested targeted landmarks with a posterior proximal counter-incision situated at about 14cm above the olecranon fossa.


METHODS
IV.
Hand, upper limb and peripheral nerve surgery department, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France. Electronic address: t.waitzenegger@gmail.com.
T
T
Waitzenegger
Orthopaedic and traumatology department, Purpan Hospital, CHU Toulouse, Toulouse, France.
P
P
Mansat
Orthopaedic and traumatology department, Raincy-Montfermeil Hospital, Montfermeil, France.
P
P
Guillon
Hand, upper limb and peripheral nerve surgery department, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France.
H
H
Lenoir
Hand, upper limb and peripheral nerve surgery department, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France.
B
B
Coulet
Hand, upper limb and peripheral nerve surgery department, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France.
C
C
Lazerges
Hand, upper limb and peripheral nerve surgery department, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France.
M
M
Chammas
D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks; D057929:Arthroplasty, Replacement, Elbow / Q000009:adverse effects*; D001843:Bone Cements / Q000009:adverse effects; D004550:Elbow / Q000294:innervation; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D006811:Humerus / Q000033:anatomy & histology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011826:Radial Nerve / Q000033:anatomy & histology / Q000293:injuries* / Q000601:surgery; D020425:Radial Neuropathy / Q000209:etiology* / Q000517:prevention & control; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D013525:Surgical Instruments / Q000009:adverse effects; D014457:Ulna / Q000033:anatomy & histology
D001843:Bone Cements
Arthroplasty; Elbow; Prevention; Radial nerve palsy; Revision