ArticleArchives of orthopaedic and trauma surgery2023
Distal locking technique affects the rate of iatrogenic radial nerve palsy in intramedullary nailing of humeral shaft fractures.
Article in Archives of orthopaedic and trauma surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 8 citations in OpenAlex.
- Does calibration technique for distal locking screw insertion reduce radiation exposure and operative time during intramedullary nailing of humeral shaft fractures in comparison with freehand technique?Surgery in practice and science · 2025Article
- Intramedullary nailing versus plate fixation for humeral shaft fractures in geriatric patients: a retrospective cohort study assessing functional outcomes and complication rates.BMC musculoskeletal disorders · 2025Article
- Nonunion and Postoperative Complications Associated With Intramedullary Nailing Versus Plate Fixation of Humeral Shaft Fractures.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2025Article
- [Complication management of shaft fractures of the upper extremities : From revision surgery to rehabilitation].Unfallchirurgie (Heidelberg, Germany) · 2025Review
- Distance of the radial nerve from distal interlocking screws in long-stem reverse shoulder arthroplasty: a cadaveric analysis.JSES international · 2025Article
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Authors and funding
8 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntramedullary humeral nailing is a common and reliable procedure for the treatment of humeral shaft fractures. Radial nerve palsy is a common complication encountered in the treatment of this pathology. The radial nerve runs from posterior to anterior at the lateral aspect of the distal humerus. Hence, there is reason to believe that due to the anatomic vicinity of the radial nerve in this area, lateral-medial distal locking in intramedullary nailing of the humerus may be associated with a greater risk for iatrogenic radial nerve injury compared to anterior-posterior locking. QUESTIONS/PURPOSE: To assess whether the choice of distal locking (lateral-medial versus anterior-posterior distal locking) in intramedullary humeral nailing of humeral shaft fractures affects the risk for iatrogenic radial nerve injury. PATIENTS AND
methodsOverall, 203 patients (116 females, mean age 64.3 ± 18.6 years), who underwent intramedullary nailing of the humerus between 2000 and 2020 at a single level-one trauma center, met the inclusion criteria and were analyzed in this retrospective case-control study. Patients were subdivided into two groups according to the distal locking technique.
resultsAnterior-posterior locking was performed in 176 patients versus lateral-medial locking in 27 patients. We observed four patients with iatrogenic radial nerve palsy in both groups. Risk for iatrogenic radial nerve palsy was almost 7.5 times higher for lateral-medial locking (OR 7.48, p = 0.006). There was no statistically significant difference regarding intraoperative complications, union rates or revision surgeries between both groups.
conclusionsLateral-medial distal locking in intramedullary nailing of the humerus may be associated with a greater risk for iatrogenic radial nerve palsy than anterior-posterior locking. Hence, we advocate for anterior-posterior locking. LEVEL OF EVIDENCE: Level III retrospective comparative study.
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