title: Transfracture medial transposition of the radial nerve associated with plate fixation of the humerus.
abstract: The aim of this study was to illustrate safety, feasibility and advantages of transfracture medial transposition of the radial nerve during the lateral approach and lateral plating of humeral fractures located in the mid and distal shaft.
  
  
  
  This was a retrospective review and analysis of medical records and radiographs of 19 patients who underwent a transfracture medial transposition of the radial nerve. Fifteen patients were treated for fresh fracture and four for nonunion. All patients were followed up clinically and radiographically for a minimum of 12 months.
  
  
  
  Pre-operative radial nerve paralysis was present in four patients in the fresh fractures group; post-operative paralysis occurred in two. All patients completely recovered a few months after the index procedure. Except for two, all patients achieved bone healing. One patient from the fresh-fracture group developed nonunion, and one from the nonunion group experienced persistent nonunion; both underwent successful revision surgeries. In addition, four patients with a fresh fracture underwent revision surgery for hardware removal. All but two patients showed no restricted elbow or shoulder joint motion compared with the opposite side.
  
  
  
  Transfracture transposition of the radial nerve during open reduction and internal fixation of humeral shaft fractures is a safe, harmless and feasible procedure when applied for fractures of the middle and distal humeral shaft; it removes the nerve from the surgical field during fracture manipulation and fixation, with a gain in length of the nerve by transforming its course from spiral to straight. Following radial nerve transposition across the fracture, a repeat surgical approach to the humerus for hardware removal or treatment of nonunion transforms the procedure into a simple one; the skin incision is carried straight down to the bone without the need to identify or dissect the nerve that was previously transposed to the medial compartment of the arm.
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Faculty of Medical Sciences, Lebanese University, Hadat, Beirut, Lebanon. achamsedine@hotmail.com.|Division of Orthopaedic and Trauma surgery, Sahel General Hospital. University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon. achamsedine@hotmail.com.
authors.forename: Ali Hassan
authors.identifier: 0000-0003-4649-1522
authors.initials: AH
authors.lastname: Chamseddine
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Faculty of Medical Sciences, Lebanese University, Hadat, Beirut, Lebanon.
authors.forename: Amer
authors.initials: A
authors.lastname: Abdallah
authors.affiliation: Division of Orthopaedic and Trauma Surgery, Faculty of Medical Sciences, Lebanese University, Hadat, Beirut, Lebanon.|Division of Orthopaedic and Trauma surgery, Sahel General Hospital. University Medical Centre, PO Box 99/25, Ghoubeiry, Beirut, Lebanon.
authors.forename: Hadi
authors.initials: H
authors.lastname: Zein
authors.affiliation: Division of Orthopaedic surgery, American University of Beirut Medical Centre, Beirut, Lebanon.
authors.forename: Assad
authors.initials: A
authors.lastname: Taha
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000009:adverse effects; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011826:Radial Nerve / Q000601:surgery*; D020425:Radial Neuropathy / Q000209:etiology*; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery
keywords: Humeral shaft fracture; Humerus nonunion; Open reduction and internal fixation; Radial nerve; Radial nerve transposition