title: Radial nerve palsy after the use of an adjuvant hinged external fixator in a complex fracture-dislocation of the elbow: a case report and review of the literature.
abstract: BACKGROUND
  The combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture is known as "terrible triad" injury of the elbow. This injury is one of the most challenging injuries of the musculoskeletal system and almost always causes instability of the elbow. The use of an adjuvant hinged external fixator in such injuries is still debated.
  
  
  METHODS
  In this case report we present a case of radial nerve palsy after setting up an adjuvant hinged external fixator in a complex fracture-dislocation of the elbow. The patient was a 39-year-old white man. A revision of his radial nerve was undertaken at 7 weeks. A radial nerve injury at two levels facing the humeral apex pins was found intraoperatively; the pins were carefully removed and partial nerve grafts done. The functional outcome at 18 months was excellent.
  
  
  CONCLUSIONS
  This case report highlights that the use of an adjuvant hinged external fixator in complex fracture -dislocation of the elbow is technically demanding and not without risk.
authors.affiliation: Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, avenue Gd-Champsec 80, 1950, Sion, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Poglia
authors.affiliation: Department of Surgery, Division of Plastic and Hand Surgery, Centre Hospitalier Universitaire Vaudois, University of Lausanne, rue du Bugnon 46, 1011, Lausanne, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Wehrli
authors.affiliation: Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, avenue Gd-Champsec 80, 1950, Sion, Switzerland.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Steinmetz
authors.affiliation: Department of Surgery, Division of Orthopaedic Surgery and Traumatology, Centre Hospitalier du Centre du Valais, avenue Gd-Champsec 80, 1950, Sion, Switzerland. philippe.zermatten@hopitalvs.ch.
authors.forename: Philippe
authors.initials: P
authors.lastname: Zermatten
mesh_terms: D000328:Adult; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D016267:External Fixators / Q000009:adverse effects*; D000072039:Fracture Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D021621:Imaging, Three-Dimensional; D008022:Ligaments / Q000293:injuries; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011826:Radial Nerve / Q000293:injuries / Q000601:surgery*; D020425:Radial Neuropathy / Q000209:etiology / Q000601:surgery*; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D000092464:Elbow Injuries
keywords: Elbow; Fracture–dislocation; Morbidity; Technique