LESION DEL NERVIO RADIAL

ASOCIADAS A FRACTURAS
JAVIER MORA SANABRIA
JUAN CAMILO MATEUS
ORTOPEDIA Y TRAUMATOLOGIA
Epidemiologia

• Las fracturas diáfisis humeral representan 1 a 3% de todas las fracturas.

• Comportamiento bimodal.
• Trauma de alta energía.

• Lesion N. radial : Fx. Tercio Proximal 2%

Fx. Tercio medio 11.5%
Fx. Tercio distal 20.7%

• Patron de fractura ( espiral, transversa) .

Management of Radial Nerve Injury Associated with Humeral Shaft Fractures: An Evidence-Based Approach. Suzanne G. Elton, M.D., 1 and Marco Rizzo, M.D.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. Mayo Clinic, 200 First St. SW, Rochester, MN 55905. J Reconstr Microsurg 2008 ;24:569–574. Copyright. 2008
Anatomía:

Management of Radial Nerve Injury Associated with Humeral Shaft Fractures: An Evidence-Based Approach. Suzanne G. Elton, M.D., 1 and Marco Rizzo, M.D.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. Mayo Clinic, 200 First St. SW, Rochester, MN 55905. J Reconstr Microsurg 2008 ;24:569–574. Copyright. 2008
 Patoanatomia:

• Fracturas simples
• Fuerzas en flexión, torsión , combinadas.
• Daño directo:
Laceración del fragmento fracturado
Tracción en el nervio
Hematoma
• Atrapamiento del nervio en los fragmentos fracturados
• Interposición de músculo
• Holstein- Lewis.
Sonographic Detection of Radial Nerve Entrapment Within a Humerus Fracture Gerd Bodner, MD, Burkart Huber, MD, Anton Schwabegger, MD, Martin Lutz, MD,
Peter Waldenberger, MD. Received April 7, 1999, from the Departments of Radiology (G.B., P.W.), Traumatology (B.H., M.L.), and Plastic Surversity Hospital of Innsbruck, Innsbruck, Austria.
Revised manuscript accepted for publication June 20, 1999.
Clasificacion de lesión nerviosa

• Seddon : I: Neuropraxia.
II: Axonotmesis
III:Neurotmesis

• Sunderland :
• Tipo I y tipo II es equivalente a los de tipos I y II de Seddon.
• Tipo III: Interrupción del axón + endoneuro.
• Tipo IV: Endoneuro y perineuro
• Tipo V tiene la separación completa del nervio.
Sonographic Detection of Radial Nerve Entrapment Within a Humerus Fracture Gerd Bodner, MD, Burkart Huber, MD, Anton Schwabegger, MD, Martin Lutz, MD,
Peter Waldenberger, MD. Received April 7, 1999, from the Departments of Radiology (G.B., P.W.), Traumatology (B.H., M.L.), and Plastic Surversity Hospital of Innsbruck, Innsbruck, Austria.
Revised manuscript accepted for publication June 20, 1999.
 Diagnostico
• Clínico:

Sonographic Detection of Radial Nerve Entrapment Within a Humerus Fracture Gerd Bodner, MD, Burkart Huber, MD, Anton Schwabegger, MD, Martin Lutz, MD,
Peter Waldenberger, MD. Received April 7, 1999, from the Departments of Radiology (G.B., P.W.), Traumatology (B.H., M.L.), and Plastic Surversity Hospital of Innsbruck, Innsbruck, Austria.
Revised manuscript accepted for publication June 20, 1999.
 Diagnostico
• Ecografia:

Adelgazamiento del nervio

(hipoecogenidad)
Fragmento de fractura dislocado

Sonographic Detection of Radial Nerve Entrapment Within a Humerus Fracture Gerd Bodner, MD, Burkart Huber, MD, Anton Schwabegger, MD, Martin Lutz, MD,
Peter Waldenberger, MD. Received April 7, 1999, from the Departments of Radiology (G.B., P.W.), Traumatology (B.H., M.L.), and Plastic Surversity Hospital of Innsbruck, Innsbruck, Austria.
Revised manuscript accepted for publication June 20, 1999.
 Diagnostico
• Electrodiagnóstico: EMG/Neuroconducción, Potenciales evocados somatosens.
No antes de 3 semanas posterior a la lesión.
Realizar 6 -12 semanas post lesion

• RMN

Sonographic Detection of Radial Nerve Entrapment Within a Humerus Fracture Gerd Bodner, MD, Burkart Huber, MD, Anton Schwabegger, MD, Martin Lutz, MD,
Peter Waldenberger, MD. Received April 7, 1999, from the Departments of Radiology (G.B., P.W.), Traumatology (B.H., M.L.), and Plastic Surversity Hospital of Innsbruck, Innsbruck, Austria.
Revised manuscript accepted for publication June 20, 1999.
Pronostico:
• Recuperación Lesion completa (77.6%)
• Lesion incompleta (98,2%)
• Fracturas cerradas (97,1%)
• fracturas abiertas (85.7%)

• 10%-20% lesion iatrogénica : solo 40% recuperación espontanea.

Management of Radial Nerve Injury Associated with Humeral Shaft Fractures: An Evidence-Based Approach. Suzanne G. Elton, M.D., 1 and Marco Rizzo, M.D.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. Mayo Clinic, 200 First St. SW, Rochester, MN 55905. J Reconstr Microsurg 2008 ;24:569–574. Copyright. 2008
Tratamiento:
• Observación expectante
• Exploracion temprana
• Exploración tardía
• Transferencias tendon

Management of Radial Nerve Injury Associated with Humeral Shaft Fractures: An Evidence-Based Approach. Suzanne G. Elton, M.D., 1 and Marco Rizzo, M.D.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. Mayo Clinic, 200 First St. SW, Rochester, MN 55905. J Reconstr Microsurg 2008 ;24:569–574. Copyright. 2008
 Observación expectante:
• Fracturas cerradas
• 70%-83% recuperación espontanea
• Uso de ecografía
• Energia del trauma
• EMG 3 semanas

Management of Radial Nerve Injury Associated with Humeral Shaft Fractures: An Evidence-Based Approach. Suzanne G. Elton, M.D., 1 and Marco Rizzo, M.D.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. Mayo Clinic, 200 First St. SW, Rochester, MN 55905. J Reconstr Microsurg 2008 ;24:569–574. Copyright. 2008

Review of Literature of Radial Nerve Injuries Associated with Humeral Fractures—An Integrated Management Strategy . YuLin Li , GuangZhi Ning , Qiang Wu, QiuLi Wu, Yan Li, ShiQing Feng.
Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, PR China. April 2, 2013; A
 Exploración temprana:
• Fractura abierta
• Lesión vascular.
• Disparo de alta velocidad
• Heridas con alta sospecha de laceración nerviosa grave
• Lesión aguda o penetrante.

Management of Radial Nerve Injury Associated with Humeral Shaft Fractures: An Evidence-Based Approach. Suzanne G. Elton, M.D., 1 and Marco Rizzo, M.D.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. Mayo Clinic, 200 First St. SW, Rochester, MN 55905. J Reconstr Microsurg 2008 ;24:569–574. Copyright. 2008
Review of Literature of Radial Nerve Injuries Associated with Humeral Fractures—An Integrated Management Strategy . YuLin Li , GuangZhi Ning , Qiang Wu, QiuLi Wu, Yan Li, ShiQing Feng.
Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, PR China. April 2, 2013; A
Exploración tardía:
• 4- 6 meses de la injuria
• Fibrosis
• Retracciones
• 85% injertados – recuperación motora

Management of Radial Nerve Injury Associated with Humeral Shaft Fractures: An Evidence-Based Approach. Suzanne G. Elton, M.D., 1 and Marco Rizzo, M.D.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. Mayo Clinic, 200 First St. SW, Rochester, MN 55905. J Reconstr Microsurg 2008 ;24:569–574. Copyright. 2008
Review of Literature of Radial Nerve Injuries Associated with Humeral Fractures—An Integrated Management Strategy . YuLin Li , GuangZhi Ning , Qiang Wu, QiuLi Wu, Yan Li, ShiQing Feng.
Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, PR China. April 2, 2013; A
 • Transferencia de tendón
Nervios irreparables
Paralisis persisente del nervio

Management of Radial Nerve Injury Associated with Humeral Shaft Fractures: An Evidence-Based Approach. Suzanne G. Elton, M.D., 1 and Marco Rizzo, M.D.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. Mayo Clinic, 200 First St. SW, Rochester, MN 55905. J Reconstr Microsurg 2008 ;24:569–574. Copyright. 2008

Review of Literature of Radial Nerve Injuries Associated with Humeral Fractures—An Integrated Management Strategy . YuLin Li , GuangZhi Ning , Qiang Wu, QiuLi Wu, Yan Li, ShiQing Feng.
Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, PR China. April 2, 2013; A
 Algoritmo

Review of Literature of Radial Nerve Injuries Associated with Humeral Fractures—An Integrated Management Strategy . YuLin Li , GuangZhi Ning , Qiang Wu, QiuLi Wu, Yan Li, ShiQing Feng.
Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, PR China. April 2, 2013; A
Casos Clinicos: