Abstract
Background
The purpose of this study was to evaluate the incidence and risk factors for axillary
nerve injury after plate fixation of humeral fractures using minimal invasive deltoid-splitting
approach. We hypothesized that the use of medial support screw (MSS) would be associated
with the outcome of axillary nerve injury.
Methods
This study retrospectively evaluated consecutive 32 patients who underwent surgical
treatments for proximal or midshaft humeral fractures. Of them, we included 26 patients
who were examined by electromyography/nerve conduction (EMG/NCV) study at 3–4 weeks
postoperatively. We excluded 6 patients because two of them were not compliant to
EMG/NCV and the remaining two died due to unrelated medical illness. Outcome assessments
included pain, functional scores, range of motion, and radiographic results.
Results
There were 8 male and 18 female patients with mean age of 67 ± 15 years. Mean duration
of follow-up period was 31 ± 11 months. The mean time to EMG/NCS after surgery was
3.5 ± 0.6 weeks. EMG/NCS examinations revealed incomplete axillary nerve injury in
8 patients (31%) without complete nerve injury. Active forward elevation at 3 months
postoperatively was significantly lower in patients with axillary nerve injury than
in those without it (99° ± 12 and 123° ± 37, respectively, p = 0.047), although final clinical outcomes were not different. At surgery, MSS was
used in 17 patients (65%), and 8 of them were associated with nerve injury. The use
of MSS was only correlated with the outcome of axillary nerve injury, because the
axillary nerve injury developed only in MSS group (p = 0.047). The MMT grade 4 in abduction strength was more common in patients with
axillary nerve injury than in those without (p = 0.037).
Conclusions
Axillary nerve injury was a concern after plate fixation of proximal humeral fracture
using minimal invasive deltoid-splitting approach. The use of medial support screw
to improve the stability could increase a risk of axillary nerve injury when used
with this approach.
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Article info
Publication history
Published online: December 02, 2021
Accepted:
November 9,
2021
Received in revised form:
November 4,
2021
Received:
September 14,
2021
Identification
Copyright
© 2021 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
