Josip Knežević1, Mario Mihalj2, Fabijan Čukelj3, Arsen Ivanišević3. 1. University Hospital Split, Department of Orthopaedic Trauma, Spinčićeva 1,21000 Split, Croatia. Electronic address: knez64@gmail.com. 2. University Hospital Split, Department of Neurology, Laboratory of Electromyoneurography, Spinčićeva va 1, Croatia. 3. University Hospital Split, Department of Orthopaedic Trauma, Spinčićeva 1,21000 Split, Croatia.
Abstract
PURPOSE: It is known that shoulder surgery may cause iatrogenic injury to the axillary nerve as a serious complication, but there is little evidence to indicate whether the axillary nerve is at risk of injury during an anterolateral acromial approach for minimally-invasive plate osteosynthesis (MIPO) of proximal humerus fractures. We hypothesised that this surgical method is safe for the axillary nerve and would preserve it from iatrogenic injury. MATERIALS AND METHODS: We conducted a prospective follow-up cohort study on 49 consecutive patients with proximal humerus fractures who were managed with MIPO through an anterolateral approach. All patients underwent standardised electroneurographic testing, with assessment of amplitudes of evoked compound muscle action potentials (CMAP) and distal motor latencies (DML) of the axillary nerves, pre- and post-operatively. Six weeks after injury, all patients underwent needle electromyographic (EMG) testing of anterior, middle, posterior deltoid, teres minor and paraspinal muscles for detecting abnormal muscle activity as a sign of acute denervation. After six months of physical rehabilitation, patients with axillary nerve injury underwent control electroneurographic testing to check the recovery of neurographic features (CMAP, DML). All nerve measurements were compared to reference values, and between right and left side. RESULTS: Five patients had a mild-to-moderate traumatic axillary nerve injury before surgery. There were no significant differences between amplitudes of CMAP (p = 0.575) and DML (p = 0.857) pre- and post-surgical procedure. CONCLUSIONS: These results confirmed safety of this surgical method in the preservation of axillary nerve from iatrogenic injury, but the course of the axillary nerve must be kept in mind.
PURPOSE: It is known that shoulder surgery may cause iatrogenic injury to the axillary nerve as a serious complication, but there is little evidence to indicate whether the axillary nerve is at risk of injury during an anterolateral acromial approach for minimally-invasive plate osteosynthesis (MIPO) of proximal humerus fractures. We hypothesised that this surgical method is safe for the axillary nerve and would preserve it from iatrogenic injury. MATERIALS AND METHODS: We conducted a prospective follow-up cohort study on 49 consecutive patients with proximal humerus fractures who were managed with MIPO through an anterolateral approach. All patients underwent standardised electroneurographic testing, with assessment of amplitudes of evoked compound muscle action potentials (CMAP) and distal motor latencies (DML) of the axillary nerves, pre- and post-operatively. Six weeks after injury, all patients underwent needle electromyographic (EMG) testing of anterior, middle, posterior deltoid, teres minor and paraspinal muscles for detecting abnormal muscle activity as a sign of acute denervation. After six months of physical rehabilitation, patients with axillary nerve injury underwent control electroneurographic testing to check the recovery of neurographic features (CMAP, DML). All nerve measurements were compared to reference values, and between right and left side. RESULTS: Five patients had a mild-to-moderate traumatic axillary nerve injury before surgery. There were no significant differences between amplitudes of CMAP (p = 0.575) and DML (p = 0.857) pre- and post-surgical procedure. CONCLUSIONS: These results confirmed safety of this surgical method in the preservation of axillary nerve from iatrogenic injury, but the course of the axillary nerve must be kept in mind.
Authors: Tommaso Maluta; Andrea Amarossi; Manuel De Masi; Andrea Dorigotti; Matteo Ricci; Eugenio Vecchini; Stefano Negri; Elena Manuela Samaila; Bruno Magnan Journal: Acta Biomed Date: 2022-03-10