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Abstract: This case is a 39-year-old female patient who suffered a humeral stem fracture due to a car accident injury and subsequently developed symptoms of radial nerve injury such as weakness and numbness in dorsal wrist extension. After fracture reduction and internal fixation surgery and subsequent nerve-nourishing drug treatment, the patient recovered muscle strength and skin numbness in the upper extremity, the humeral fracture healed, and sensation and strength in the upper extremity returned to normal, which fortunately did not result in serious consequences.
Basic information】Female, 39 years old
Type of disease】Humeral stem fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】December 2021
Treatment plan】Surgical treatment (incision and internal fixation) + oral medication (methylcobalamin tablets)
Treatment period】2 weeks of inpatient treatment and regular outpatient follow-up
Results】Fracture healing, upper limb sensation and strength restored to normal
I. Initial consultation
The patient, a 39-year-old female, was brought to the emergency room by 120 for a car accident injury. According to the patient’s description, she was waiting for a red light normally, but she was hit by a car that ran the red light, and her whole body was dazed at that time, and she was not fully awake until the hospital. Her own arm was broken by the car and she only learned about it later. Through preliminary examination, it could be seen that the patient’s arm was clearly deformed with swelling and bruising. The sound of bones rubbing together could be vaguely felt. The patient’s skin temperature was good and the radial artery pulsation was palpable, but the dorsal extension of the wrist was weak and the skin on the back of the hand felt numb. The patient’s humerus was seen to be broken into several segments on the x-ray, with one spiral bone fragment extending diagonally far down. The patient was diagnosed with a humeral stem fracture combined with radial nerve contusion.
(X-ray)
II. Treatment history
The patient and family were explained that surgery was the treatment of choice for this comminuted fracture with nerve damage. The patient was admitted to the hospital on an emergency basis, and the upper extremity posture was temporarily maintained using an upper extremity sling. Preoperative tests such as upper extremity vascular ultrasound, routine blood count, liver and kidney function, and coagulation items were completed. On the third day after admission, an incision and internal fixation of the fracture was performed, and the radial nerve near the fracture end was explored and released during the operation.
III. Treatment effect
After 2 weeks of hospitalization, the patient’s wound healed smoothly and the stitches were removed, the wound healed well, there was no bleeding and no infection, the patient had no obvious pain in the forearm, the deformity was corrected and there was some swelling, at this time the patient felt that the wrist joint and the dorsal extension of the thumb were still weak, the skin of the back of the hand felt numb, the shoulder and elbow joint activities returned to normal, and the patient was discharged. Six weeks after discharge, the patient’s numbness and weakness of the hand were relieved on outpatient review. Three months later, the patient’s muscle strength was basically restored, the numbness of the skin disappeared, the fracture basically healed, and the sensation and strength of the upper limb returned to normal.
IV. Notes
We are glad that the patient’s humeral trunk fracture is well aligned by incision and internal fixation, but the recovery of the contused nerve is much slower. Therefore, patients need to be advised that they need regular outpatient follow-up after discharge, and that they need to review X-ray films to observe fracture healing at 3 months, 6 months and 1 year after discharge, and that the internal fixation plate can be kept in the body for a long time if there are no uncomfortable symptoms. For nerve injury, acupuncture and electrical stimulation can be performed at a nearby rehabilitation hospital or Chinese medicine hospital. During the fracture recovery period, it is necessary to pay attention to the joint activities of the upper limb and avoid carrying heavy objects and strenuous activities of the affected limb to avoid affecting the recovery of the disease.
V. Personal insight
The radial nerve passes almost against the surface of the bone in the middle and lower 1/3 of the humeral stem. This patient had symptoms of radial nerve injury after the humeral stem fracture, which showed weakness of forearm wrist extension and finger extension and numbness of hand skin sensation. After surgical exploration and release, it is necessary to continue oral neurotrophic drug therapy, supplemented by rehabilitation therapy, which can often achieve very good treatment results.