Reconstruction for Nerve Palsy -Tendon Transfers and Nerve transfers-Case: Reconstruction for Nerve Palsy -Tendon Transfers and Nerve transfers

Case: Reconstruction for Nerve Palsy -Tendon Transfers and Nerve transfers

Pdf Summary

This case vignette discusses a 36-year-old male who sustained a gunshot wound to his left arm and subsequently developed a ballistic humerus fracture. Initially, there was no radial nerve function on examination. The patient underwent open reduction and internal fixation (ORIF) of the left humerus, during which the radial nerve was noted to be intact. However, at the post-operative follow-up, there was still no recovery of radial nerve function. <br /><br />The pertinent questions in this case include the role of electrodiagnostic testing and the timing of electromyography/nerve conduction studies (EMG/NCS). At three months, with no evidence of recovery, the options include operative approaches such as nerve transfer or tendon transfer, as well as non-operative management. <br /><br />Electrodiagnostic testing is performed, which confirms no evidence of recovery. However, despite the lack of radial nerve function, the patient has a supple wrist and hand at three months. Based on this finding, the decision is made to proceed with Brand Radial Nerve Tendon Transfers. Specifically, the extensor carpi radialis brevis tendon is transferred to the extensor carpi radialis longus (ECRL) tendon for wrist extension, the flexor carpi radialis tendon is transferred to the extensor digitorum communis tendon for finger extension, and the palmaris longus tendon is transferred to the extensor pollicis longus tendon for thumb extension. <br /><br />Discussion points in this case include the level of injury, timing of intervention, diagnostic tests, and the role of pre-operative therapy. Additionally, operative techniques such as nerve transfer versus tendon transfer are discussed. Images of the Pulvertaft Weave technique and the tendon transfers are provided for reference.<br /><br />In summary, this case presents a patient with no recovery of radial nerve function following a humerus fracture. Electromyography and nerve conduction studies confirm no evidence of recovery, and tendon transfers are performed to restore wrist, finger, and thumb extension.

Keywords

gunshot wound

ballistic humerus fracture

radial nerve function

open reduction and internal fixation

electrodiagnostic testing

nerve conduction studies

operative approaches

nerve transfer

tendon transfer

pre-operative therapy