Woo-Yong LEE, Hyun-Dae SHIN, Kyung-Cheon KIM, Soo-Min CHA, Yoo-Sun JEON

Relationship between incidence of postoperative radial nerve palsy and surgical experience in the treatment of humeral shaft fractures through a posterior triceps splitting approach: A retrospective study

Objective: The aim of this study was to investigate the incidence of postoperative radial nerve palsy (PORNP) after the surgicaltreatment of humeral shaft fractures through a posterior triceps splitting approach by a single surgeon’s experience in aconsecutive case series from a single trauma center.Methods: In this retrospective study, a total of 118 patients (82 male, 36 female; mean age = 48 years, age range = 16 – 80 years) whounderwent open reduction and plate fixation through posterior triceps splitting approach due to humeral shaft fractures at a level Itrauma center were included. Level of the fractures was categorized as the proximal third, middle third, and distal third of thediaphysis, and then all the fractures were classified according to the AO/OTA classification system. The trend of incidence ofPORNP was investigated. All the operations were performed by a single surgeon. The recovery time of PORNP was also recorded.Results: There were 13 cases of proximal third, 67 cases of middle third, and 38 cases of distal third fracture. Based on AO/OTAclassification, there were 29 cases of A1-type, 23 cases of A2-type, 42 cases of A3-type, 17 cases of B2-type, 3 cases of B3-type, and4 cases of C2-type fracture. The overall incidence of PORNP was 11% (13 cases). All the PORNP cases fully recovered within 10.3± 10.4 weeks (range = 1 – 44) with conservative treatment. Incidence of PORNP significantly decreased with increase in surgicalexperience (P = 0.009). The incidence of radial nerve palsy was not significantly related to the level of the fracture (P = 0.199). Theincidence of radial nerve palsy was not significantly related with the fracture pattern according to AO/OTA classification (P =0.659).Conclusion: Evidence from this study has shown that the incidence of PORNP following the posterior triceps splitting approachfor the treatment of humeral shaft fractures is significantly associated with the surgeon’s experience.Level of Evidence: Level IV, Therapeutic Study

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