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Radial Nerve Injury

  • Anjan P. Kaushik
  • Warren C. Hammert
Reference work entry

Abstract

Radial nerve palsy in the child can be attributed to a variety of traumatic causes, including humeral shaft, supracondylar humerus, and Monteggia fractures, as well as congenital and pathologic etiologies. Most pediatric injuries to the radial nerve have a favorable prognosis with observation, protective splinting, and therapy. Patients who fail to recover neurologic function after 3–6 months, however, require surgical exploration for neurolysis, nerve repair, or nerve grafting. Primary repair has better outcomes than grafting or nerve transfers, provided that a well-vascularized tissue bed is available and minimal tension is placed on the repair.

Keywords

Radial Head Radial Nerve Humeral Shaft Nerve Grafting Tendon Transfer 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

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References

  1. Abu-Jayyab Z, Abu-Zidan F, Marlovits S. Fracture dislocation of the lateral condyle and medial epicondyle of the humerus associated with complete radial nerve transection. J Pak Med Assoc. 2011;61(9):920–1.PubMedGoogle Scholar
  2. Alsubhi FS, Althunyan AM, Curtis CG, Clarke HM. Radial nerve palsy in the newborn: a case series. CMAJ. 2011;183(12):1367–70.PubMedCentralPubMedCrossRefGoogle Scholar
  3. Amillo S, Barrios RH, Martínez-Peric R, Losada JI. Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma. 1993;7(3):211–5.PubMedCrossRefGoogle Scholar
  4. Austin R. Tardy palsy of the radial nerve from a Monteggia fracture. Injury. 1976;7(3):202–4.PubMedCrossRefGoogle Scholar
  5. Babal JC, Mehlman CT, Klein G. Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop. 2010;30(3):253–63.PubMedCrossRefGoogle Scholar
  6. Birch R. Nerve repair. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2010. p. 1035–74.Google Scholar
  7. Birch R, Achan P. Peripheral nerve repairs and their results in children. Hand Clin. 2000;16(4):579–95.PubMedGoogle Scholar
  8. Brown IC, Zinar DM. Traumatic and iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop. 1995;15(4):440–3.PubMedCrossRefGoogle Scholar
  9. Clark WL, Trumble TE, Swiontkowski MF, Tencer AF. Nerve tension and blood flow in a rat model of immediate and delayed repairs. J Hand Surg Am. 1992;17(4):677–87.PubMedCrossRefGoogle Scholar
  10. Colditz J. Splinting for radial nerve palsy. J Hand Ther. 1987;1:18–23.CrossRefGoogle Scholar
  11. Coppotelli BA, Lonsdale JD, Kass E. Sclerema neonatorum complicated by radial nerve palsy following nontraumatic delivery. Mt Sinai J Med. 1979;46:143–4.PubMedGoogle Scholar
  12. Culp RW, Osterman AL, Davidson RS, Skirven T, Bora Jr FW. Neural injuries associated with supracondylar fractures of the humerus in children. J Bone Joint Surg Am. 1990;72(8):1211–5.PubMedGoogle Scholar
  13. Dormans JP, Squillante R, Sharf H. Acute neurovascular complications with supracondylar humerus fractures in children. J Hand Surg Am. 1995;20(1):1–4.PubMedCrossRefGoogle Scholar
  14. Ekholm R, Ponzer S, Tornkvist H, Adami J, Tidermark J. The Holstein-Lewis humeral shaft fracture: aspects of radial nerve injury, primary treatment, and outcome. J Orthop Trauma. 2008;22(10):693–7.PubMedCrossRefGoogle Scholar
  15. Finsterbush A, Husseini N. Infantile cortical hyperostosis with unusual clinical manifestations. Clin Orthop Relat Res. 1979;144:276–9.PubMedGoogle Scholar
  16. Flynn JC, Matthews JG, Benoit RL. Blind Pinning of Supracondylar Fractures of the Humerus in Children. J Bone Joint Surg (AM) 1974; 56:263–272.Google Scholar
  17. Galbraith KA, McCullough CJ. Acute nerve injury as a complication of closed fractures or dislocations of the elbow. Injury. 1979;11:159–64.PubMedCrossRefGoogle Scholar
  18. Gaur SC, Swarup A. Radial nerve palsy caused by injections. J Hand Surg Br. 1996;21:338–40.PubMedCrossRefGoogle Scholar
  19. Gosens T, Bongers KJ. Neurovascular complications and functional outcome in displaced supracondylar fractures of the humerus in children. Injury. 2003;34(4):267–73.PubMedCrossRefGoogle Scholar
  20. Hayman M, Roland EH, Hill A. Newborn radial nerve palsy: report of four cases and review of published reports. Pediatr Neurol. 1999;21(3):648–51.PubMedCrossRefGoogle Scholar
  21. Holst-Nielsen F, Jensen V. Tardy posterior interosseous nerve palsy as a result of an unreduced radial head dislocation in Monteggia fractures: a report of two cases. J Hand Surg Am. 1984;9:572–5.PubMedCrossRefGoogle Scholar
  22. Hosalkar HS, Matzon JL, Chang B. Nerve palsies related to pediatric upper extremity fractures. Hand Clin. 2006;22(1):87–98.PubMedCrossRefGoogle Scholar
  23. Ingari JV, Green DP. Radial nerve palsy. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2010. p. 1075–92.Google Scholar
  24. Isaac S, Athanasou NA, Pike M, Burge PD. Radial nerve palsy owing to localized hypertrophic neuropathy (intraneural perineurioma) in early childhood. J Child Neurol. 2004;19(1):71–5.PubMedCrossRefGoogle Scholar
  25. Jessing P. Monteggia lesions and their complicating nerve damage. Acta Orthop Scand. 1975;46(4):601–9.PubMedCrossRefGoogle Scholar
  26. Kallio PK, Vastamaki M, Solonen KA. The results of secondary microsurgical repair of radial nerve in 33 patients. J Hand Surg Am. 1993;18(3):320–2.CrossRefGoogle Scholar
  27. Krusche-Mandl I, Aldrian S, Kottstorfer J, Seis A, Thalhammer G, Egkher A. Crossed pinning in paediatric supracondylar humerus fractures: a retrospective cohort analysis. Int Orthop. 2012;36(9):1893–8.PubMedCentralPubMedCrossRefGoogle Scholar
  28. Lapid O, Ho ES, Goia C, Clarke HM. Evaluation of the sensory deficit after sural nerve harvesting in pediatric patients. Plast Reconstr Surg. 2007;119(2):670–4.CrossRefGoogle Scholar
  29. Larsen LB, Barfred T. Radial nerve palsy after simple fracture of the humerus. Scand J Plast Reconstr Surg Hand Surg. 2000;34(4):363–6.PubMedCrossRefGoogle Scholar
  30. Lee FY, Schoeb JS, Yu J, Christiansen BD, Dick HM. Operative lengthening of the humerus: indications, benefits, and complications. J Pediatr Orthop. 2005;25(5):613–6.PubMedCrossRefGoogle Scholar
  31. Lee YH, Chung MS, Gong HS, Chung JY, Park JH, Baek GH. Sural nerve autografts for high radial nerve injury with nine centimeter or greater defects. J Hand Surg Am. 2008;33(1):83–6.PubMedCrossRefGoogle Scholar
  32. Lejman T, Strong M, Michno P. Radial-nerve palsy associated with septic shoulder in neonates. J Pediatr Orthop. 1995;15:169–71.PubMedCrossRefGoogle Scholar
  33. Louahem DM, Nebunescu A, Canavese F, Dimeglio A. Neurovascular complications and severe displacement in supracondylar humerus fractures in children: defensive or offensive strategy? J Pediatr Orthop B. 2006;15(1):51–7.PubMedCrossRefGoogle Scholar
  34. Lundy CT. Commentary: radial nerve palsy in the newborn. CMAJ. 2011;183(12):1348–9.PubMedCentralPubMedCrossRefGoogle Scholar
  35. Lundy CT, Goyal S, Lee S, Hedderly T. Bilateral radial nerve palsy in a newborn. Neurology. 2009;72(6):576.PubMedCrossRefGoogle Scholar
  36. Mackinnon SE, Roque B, Tung TH. Median to radial nerve transfer for treatment of radial nerve palsy: case report. J Neurosurg. 2007;107:666–71.PubMedCrossRefGoogle Scholar
  37. Marcu DM, Balts J, McCarthy JJ, Kozin SH, Noonan KJ. Iatrogenic radial nerve injury with cannulated fixation of medial epicondyle fractures in the pediatric humerus: a report of 2 cases. J Pediatr Orthop. 2011;31(2):e13–6.PubMedCrossRefGoogle Scholar
  38. McDonnell DP, Wilson JC. Fracture of the lower end of the humerus in children. J Bone Joint Surg Am. 1948;30:347–58.Google Scholar
  39. Moore TM, Klein JP, Patzakis MJ, Harvey JP. Results of compression-plating of closed Galeazzi fractures. J Bone Joint Surg Am. 1985;67(7):1015–21.PubMedGoogle Scholar
  40. Morgan L. Radial nerve paralysis in the newborn. Arch Dis Child. 1948;23(114):137–9.PubMedCentralPubMedCrossRefGoogle Scholar
  41. Morris AH. Irreducible Monteggia lesion with radial-nerve entrapment: a case report. J Bone Joint Surg Am. 1974;56(8):1744–6.PubMedGoogle Scholar
  42. Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma. 1998;45(1):116–22.PubMedCrossRefGoogle Scholar
  43. Ogawa K, Yoshida A. Throwing fracture of the humeral shaft: an analysis of 90 patients. Am J Sports Med. 1998;26(2):242–6.PubMedGoogle Scholar
  44. Ogawa BK, Kay RM, Choi PD, Stevanovic MV. Complete division of the radial nerve associated with a closed fracture of the humeral shaft in a child. J Bone Joint Surg Br. 2007;89(6):821–4.PubMedCrossRefGoogle Scholar
  45. Omer GE. Injuries to nerves of the upper extremity. J Bone Joint Surg Am. 1974;56(8):1615–24.PubMedGoogle Scholar
  46. Osamura N, Ikeda K, Hagiwara N, Tomita K. Posterior interosseous nerve injury complicating ulnar osteotomy for a missed Monteggia fracture. Scand J Plast Reconstr Surg Hand Surg. 2004;38(6):376–8.PubMedCrossRefGoogle Scholar
  47. Pandian JD, Bose S, Daniel V, Singh Y, Abraham AP. Nerve injuries following intramuscular injections: a clinical and neurophysiological study from northwest India. J Peripher Nerv Syst. 2006;11(2):165–71.PubMedCrossRefGoogle Scholar
  48. Ray WZ, Mackinnon SE. Clinical outcomes following median to radial nerve transfers. J Hand Surg Am. 2011;36(2):201–8.PubMedCentralPubMedCrossRefGoogle Scholar
  49. Regan PJ, Roberts JO, Bailey BN. Acute posterior interosseous nerve palsy caused by bleeding from an arteriovenous malformation. J Hand Surg Am. 1991;16(2):272–3.PubMedCrossRefGoogle Scholar
  50. Royce RO, Dutkowsky JP, Kasser JR, Rand FR. Neurologic complications after K-wire fixation of supracondylar humerus fractures in children. J Pediatr Orthop. 1991;11(2):191–4.PubMedCrossRefGoogle Scholar
  51. Ruchelsman DE, Pasqualetto M, Price AE, Grossman JAI. Persistent posterior interosseous nerve palsy associated with a chronic type I Monteggia fracture-dislocation in a child: a case report and review of the literature. Hand. 2009;4(2):167–72.PubMedCentralPubMedCrossRefGoogle Scholar
  52. Sairyo K, Henmi T, Kanematsu Y, Nakano S, Kajikawa T. Radial nerve palsy associated with slightly angulated pediatric supracondylar humerus fracture. J Orthop Trauma. 1997;11(3):227–9.PubMedCrossRefGoogle Scholar
  53. Seckel BR, Ryan SE, Simons JE, Gagne RG, Watkins Jr E. Vascularized versus nonvascularized nerve grafts: an experimental structural comparison. Plast Reconstr Surg. 1986;78(2):211–20.PubMedCrossRefGoogle Scholar
  54. Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV. Radial nerve palsy associated with fracture of the shaft of the humerus: a systematic review. J Bone Joint Surg Br. 2005;87-B:1647–52.CrossRefGoogle Scholar
  55. Shergill G, Bonney G, Munshi P, Birch R. The radial and posterior interosseous nerves. Results for 260 repairs. J Bone Joint Surg Br. 2001;83(5):646–9.PubMedCrossRefGoogle Scholar
  56. Singh R, Mechelse K, Hop WC, Braakman R. Long-term results of transplantations to repair median, ulnar, and radial nerve lesions by a microsurgical interfascicular autogenous cable graft technique. Surg Neurol. 1992;37:425–31.PubMedCrossRefGoogle Scholar
  57. Slutsky DJ. A practical approach to nerve grafting in the upper extremity. Atlas Hand Clin. 2005;10:73–92.CrossRefGoogle Scholar
  58. Smith FM, Joyce III JJ. Fracture of lateral condyle of humerus in children. Am J Surg. 1954;87:324–9.PubMedCrossRefGoogle Scholar
  59. Spinner M, Freundlich BD, Teicher J. Teicher J. Posterior interosseous nerve palsy as a complication of Monteggia fractures in children. Clin Orthop. 1968;58:141–5.PubMedCrossRefGoogle Scholar
  60. Staniforth P, Fisher TR. The effects of sural nerve excision in autogenous nerve grafting. Hand. 1978;10(2):187–90.PubMedCrossRefGoogle Scholar
  61. Stein F, Grabias SL, Deffer PA. Nerve injuries complicating Monteggia lesions. J Bone Joint Surg Am. 1971;53-A:1432–6.Google Scholar
  62. Szekeres M. Tenodesis extension splinting for radial nerve palsy. Tech Hand Up Extrem Surg. 2006;10(3):162–5.PubMedCrossRefGoogle Scholar
  63. Tollner U, Bechinger D, Pohlandt F. Radial nerve palsy in a premature infant following long-term measurement of blood pressure. J Pediatr. 1980;96:921–2.PubMedCrossRefGoogle Scholar
  64. Tomaszewski R, Gap A, Wozowicz A, Wysocka P. Analysis of early vascular and neurological complications of supracondylar humerus fractures in children. Pol Orthop Traumatol. 2012;77:101–4.PubMedGoogle Scholar
  65. Tubbs RS, Griessenauer C, Rizk E, Shoja MM, Pehler SF, Wellons JC, Conklin MJ. Posterior interosseous nerve palsy in a child associated with recurrent dislocation of the head of the radius. J Nuerosurg Pediatrics, 2013; 11:389–391.Google Scholar
  66. Uchida Y, Sugioka Y. Peripheral nerve palsy associated with congenital constriction band syndrome. J Hand Surg Br. 1991;16(1):109–12.PubMedCrossRefGoogle Scholar
  67. Wang MN, Chang WN. Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision. J Orthop Trauma. 2006;20:1–5.PubMedCrossRefGoogle Scholar
  68. Wang D, Liu XL, Zhu JK, et al. Repairing large radial nerve defects by acellular nerve allografts seeded with autologous bone marrow stromal cells in a monkey model. J Neurotrauma. 2010;27(10):1935–43.PubMedCrossRefGoogle Scholar
  69. Waters PM, Bae DS. Traumatic peripheral nerve injuries; chapter 37. In: Waters PM, Bae DS, editors. Pediatric hand and upper limb surgery: a practical guide. Philadelphia: Lippincott, Williams, and Wilkins; 2012. p. 462–77.Google Scholar
  70. Weinzweig N, Barr A. Radial, ulnar, and median nerve palsies caused by a congenital constriction band of the arm: single-stage correction. Plast Reconstr Surg. 1994;94(6):872–6.PubMedCrossRefGoogle Scholar
  71. Wiley JJ, Galey JP. Monteggia injuries in children. J Bone Joint Surg Br. 1985;67-B(5):728–31.Google Scholar
  72. Wilson JN. Fracture of the external condyle of the humerus in children. Br J Surg. 1936;18:299–316.Google Scholar
  73. Yang CB, Huang SC. Humeral lengthening using the Ilizarov technique. J Formos Med Assoc. 1997;96(4):291–4.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryUniversity of Rochester Medical CenterRochesterUSA

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