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Radial nerve injury should be treated?Humerus closed fractures complicated by radial nerve damage, mostly in nerve contusion, and less for the rupture, the general conservative treatment first, in March after failed surgical exploration.
1. Axilla and upper arm radial nerve radial nerve revealed axillary exposure, starting from the axillary midline incision along the medial upper arm, upper arm medial cutaneous nerve exposed in the deep to the axillary artery and vein and the median, ulnar nerve to the front retractor in the rear to expose the radial nerve; on the arm radial nerve cut revealed by the posterior deltoid 1 / 3 the beginning, middle upper arm outward to the outer surface of the bottom (Figure 3), and then along the brachioradialis muscle before cut edge down to the elbow, in the long head and lateral head of triceps between the exposed radial nerve in the proximal upper arm, following the cut in the outer edge of the lateral head of triceps (Fig. 4), in brachioradialis muscle, biceps and the separation between the brachioradialis muscle, to pull back to open brachioradialis muscle, deep in the thick of the arm is the radial nerve in the distal segment.,2. Elbow and forearm, along the radial nerve in the exposed leading edge of brachioradialis muscle to continue to cut, to expose the superficial branch of radial nerve and deep, superficial branch of the bifurcation, the deep branch of the deep surface by the brachioradialis muscle supinator into the deep an


d shallow between the two layers, shall mean the total extensor carpi extensor and retractor to both sides in the lower edge of the supinator seen piercing the deep branch of its branches, according to intraoperative nerve lesions seen in the corresponding nerve surgery.
In terms of treatment, mainly the following points require attention:
1, in accordance with nerve decompression injury, suture lysis, or, if necessary, with the elbow, shoulder flexion and adduction method to overcome the defects such as neural forward, such as defects in as many as nerve grafting, nerve anastomosis was better than median nerve ulnar nerve as well.
2, if not repaired nerves, may be imposed forearm flexor extensor tendon transfer is a function of reconstruction, better, less severely affected triceps paralysis, muscle relaxation and the force of gravity due to elbow elbow extension can .
3, the nerve did not recover before the suspension spring clip board can be used to reduce excessive extensor stretch, affect the efficacy.Prognosis is usually poor.

First, clinical features and diagnostic
(A) of the deformity: As the wrist, extension of thumb, extensor muscles paralyzed hand was "drooping wrist" deformity. The following graphic elbow injury, the extensor carpi radialis muscle branch has been issued, it can be Beishen wrist, but the radial deviation, extension of thumb extensor can not.
(B) the feeling of injury in the back of the hand radial side of the second half of the upper arm and forearm, radial side of the back of the rear feeling diminish or disappear.
(C) motion after radial nerve injury in the upper arm, the extensor extensive paralysis, resulting in drooping wrist, thumb and all fingers are down, can not Shenzhang knuckles; forearm supination can not have pronation deformity, thumb adduction deformity.
Check the triceps and wrist extensor muscles should be in anti-gravity direction. After losing the role of thumb abduction, can not stabilize the metacarpophalangeal joint, the thumb with severe dysfunction. Because of the extensor carpi ulnaris and extensor carpi paralysis, difficulty in the wrist to the sides. Obvious dorsal forearm muscle atrophy. Injury of radial nerve in the forearm bone, mostly between the dorsal nerve injury, sensory and triceps, elbow muscle, extensor carpi were not affected.
Second, treatment with nerve decompression as needed, release or suture. When necessary, with elbow, shoulder flexion and adduction and other methods to overcome the defects of neural forward. Nerve anastomosis was better than the median nerve and ulnar nerve as well. If you can not repair nerve, can be used is the forearm flexor tendon transfer to improve function. Paralysis of the triceps less severe, due to elbow muscle relaxation and gravity can elbow extension. Nerve did not recover before the suspension spring clip board can be used to maintain wrist dorsiflexion.
Third, the radial nerve revealed
(A) of the radial nerve in the exposed upper arm
1. Incision from the deltoid muscle after the origin, along with the lateral head of triceps long head down between the groove cut to the outside of the upper arm before turning the middle, and finally the brachial muscle and brachioradialis interscalene, length 15 ~ 20cm
2. Free and retract flaps, cut deep fascia, along with the lateral head of triceps long head of the separation between the ditch.
3. Retractor long head and lateral head of triceps, dissection of the radial nerve and deep brachial artery with the line, until the deep surface of the lateral head of triceps. Long head of triceps stretch, pay attention not to damage the front line to go inside of the ulnar nerve.
4. Arm slightly external rotation, and in the brachioradialis muscle and brachioradialis muscle beginning part of the deep fascia between the cut along the gap to the deep muscle separation. Radial nerve in the anterolateral humeral muscle here in the depths of space.
5. Retractor muscle and the brachioradialis brachioradialis muscle to expose the radial nerve. In order to facilitate exposure of the radial nerve deep to the triceps, the triceps can be the beginning of the lateral head of the Department of slightly separated.
6. Retractor triceps lateral head back to expose the dark side of the radial nerve.
(B) of the elbow and forearm radial nerve in the exposed upper
1. Incision to the elbow joint as the center, along the leading edge of brachioradialis medial incision for 10 ~ 12cm. Elbow flexion should be avoided across the joint profile, bend curved lateral incision, so as not to cause scar contracture deformity. Lateral cutaneous nerve of forearm (musculocutaneous nerve cutaneous branch) in the brachial two foreign piercing the deep fascia under the tendon, the lateral line at the elbow prior to the skin, careful not to damage.
2. Incision of the deep fascia, the top along the brachioradialis muscle and brachioradialis muscle to the deep gap separating the lower part along the brachioradialis muscle and brachial two pronator tendon and the separation between the circular muscle.
3. Exposed to the outside of the radial nerve retractor brachioradialis muscle, the medial brachial retractor muscle, biceps, and pronator muscle round, deep in the incision, the humerus can be seen in front of the radial nerve and its muscular branches to the elbow in the vicinity joint action for the depth of two, pay attention not to injury.
(C) of the deep branch of radial nerve (dorsal interosseous nerve) is exposed in front of the radial nerve in the elbow, along the brachial muscle and down between the brachioradialis muscle in the elbow into the depth of two. Deep branch (posterior interosseous dorsal) below the ramp outside, through the supinator, radial neck turning around the dorsal forearm, the dominant forearm extensor group.
1. Incision from the epicondyle of the humerus from the front, back slightly curved bottom, along the short extensor carpi extensor and finger between the total cut down, about 8 ~ 10cm.
2. In short radial extensor of wrist and finger extensor total clearance cut deep fascia along the muscle gap separation. The radial side of wrist long and short radial extensor is retracted to expose the supinator, the distal edge of supinator find the deep branch of radial nerve.
3. Such as the scar and more difficult deep branch of radial nerve in the distal margin of the supinator found, can brachioradialis muscle and the length of the extensor carpi cut deep fascia along the muscle between the separation space, revealing the deep surface of supination muscle (under the external oblique muscle fibers), in the search for the muscle on the edge of the radial nerve.
4. Along the deep branch of radial nerve distal to the separation, to identify the nerve piercing the distal edge of the supinator, pay attention not to damage the muscle branch.
5. In order to reveal the deep branch of radial nerve through the supinator part, if necessary, part of the muscle cut, pay attention not to damage nerves.
(D) ends of the radial nerve surgery in the past that embedded within the muscle, nerve, 1.5 to 2 years after fracture, muscle degeneration of motor endplates and even disappear, and can not regenerate. Many scholars have done in recent years, motor end plate regeneration research, confirmed that the motor end plate can be regenerated. Consistent with nerve or muscle to motor nerve implantation, the muscles in the formation of new motor end plate, so to regain nerve. Clinically, the muscle on the radial nerve at the fracture in the past, can not find a complete distal ends, or when the distal anastomosis is not damaged, the neural stump buried near paralysis of the muscles, has achieved good results. Concrete steps are: the usual stump exposed near, removal of neuroma, stripped of epineurium under a microscope, the beam ends embedded into the muscle 3 to 5 within the outer membrane and the sarcolemma proximal suture needle 1 to 2 fixed to prevent loss. If the nerve defect, can not be directly embedded in muscle, nerve and then buried in a portable muscle after cast immobilization. Will be buried should be noted that the health of the muscle nerve to avoid scarring. If the muscle is damaged, scar, scar tissue should be buried in the distal nerve muscle.



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