Objectives: The functional recovery after reconstruction of radial nerve injuries associated with high energy humerus fractures is generally poor. The purpose of this study is to evaluate the functional and clinical outcomes of intermediate-level radial nerve injuries due to high energy humeral fractures, treated with sural nerve grafting.
Methods: From 1994 to 2010, eleven patients (8 male, 3 female mean age: 33.1) with high energy humerus fractures associated at radial nerve palsy were treated with sural nerve grafting besides fracture fixation. Etiologies were traffic accidents in 7 patients and work-related accidents in 4 patients. The length of radial nerve gap was 10 cm in six patients, 9 cm in one patients, 8 cm in three patients and 4 cm in one patient The mean time interval between injury and the surgical intervention was 108.1 (range: 0-330) days. The functional results were evaluated according to system of Verga. Clinical results were assessed by, grip and pinch strengths.
Results: The mean time for beginning to demonstrate initial contractions of the radial wrist extensors at was 10.7 months. The mean time to follow-up from deliver to study was 68.6 months. The individual muscle power according to Verga scoring system was excellent in 6, good in 1, fair in 2 and poor in 2 patients. All patients achieved a mean grip strength 58% of unaffected hands and a mean maximum key pinch strength was achieved 67% of unaffected hands. All fractures were healed.
Conclusion: Prolonged external fixation and extensive crush arm injuries can decrease the success of nerve healing. Excluding these conditions, good functional results may be obtained with nerve grafts longer than eight cm associated with high energy humeral fractures.
Humerus fracture, radial nerve graft