Neuropraxia Radial Fratura Diafisária do Úmero TRATAMENTO - Clínica de Fisioterapia Dr. Robson Sitta

▼ Contact: (11) 2528.4661 - www.fisiositta.com.br Dr. ROBSON SITTA PHYSIOTHERAPY CLINIC Rua Coriolano 1480 - Vila Romana (Lapa), São Paulo (SP) - Brazil FOLLOW US ON SOCIAL MEDIA: ▼ YOUTUBE: https://www.youtube.com/channel/UCb7a... ▼ INSTAGRAM:   / robson.sitta   ▼ FACEBOOK: https://www.facebook.com/fisiositta?f... ▼ LINKEDIN:   / robson-sit.  . ▼ WEBSITE: www.fisiositta.com.br #physiotherapy #orthopedics #manualtherapy #robsonsitta PHYSIOTHERAPY SPECIALIZED IN ORTHOPEDICS & MANUAL THERAPY Postoperative physical therapy treatment for humeral shaft fracture with radial nerve neuropraxia .......................................... Humeral Fracture Humeral shaft fractures are very common, representing approximately 3 to 5% of all fractures. Good results have been reported with non-operative treatment (Sarmiento). However, segmental fractures associated with forearm fractures, neurovascular injuries, exposed fractures, pathological fractures, bilateral fractures, multiple trauma, worsening or new neurological injuries, quadriplegics, brachial plexus injuries, and failure of conservative treatment are indications for surgical stabilization (Brinker). Humeral shaft fractures occur bimodally, with two peaks: the first between 21 and 30 years of age, the second in older patients, between 60 and 80 years of age, primarily females (Pollock). High-energy trauma is primarily responsible for the first peak in young patients, and osteoporosis is responsible for the second peak. The observation of humeral fractures in patients with osteoporosis provides a good opportunity to investigate the primary cause of this disease (Tytherleigh-Strong). What is the incidence of radial nerve injury in humeral shaft fractures? Radial nerve palsy occurs in approximately 12% of patients. There is a direct relationship between the severity of the trauma and the presence of radial nerve injuries in humeral shaft fractures. Fractures of the middle and distal third are more frequently associated with radial nerve injuries than those of the proximal third. Fractures with a transverse and spiral pattern are more closely related to radial nerve injury than those with an oblique or comminuted pattern. Approximately 71% of patients showed spontaneous recovery, 88% of them after surgical exploration (Shao). In a series of 620 patients treated with a brace, Sarmiento found 67 patients with radial nerve palsy, and only one patient did not experience spontaneous functional recovery. When evaluating radial nerve injury, it is important to determine the timing of the injury. If the injury occurs at the time of trauma, in most cases, we have neuropraxia and can wait for spontaneous recovery, which occurs in most cases. Radial nerve exploration becomes mandatory in patients who develop progressive loss of neurological function or if this occurs after manipulation of the fracture site or immobilization. In these cases, the nerve is likely interposed within the fracture site, and this also constitutes a contraindication for the placement of closed-focus intramedullary nails. In exposed fractures where the radial nerve is initially paralyzed, it should be explored at the time of surgical cleaning. There is no definitive evidence regarding the length of time to wait before exploring a paralyzed radial nerve, but the suggested minimum time is 8 weeks and the maximum is six months (Shao). What are the criteria for indicating surgical treatment after failure of non-operative treatment? Humeral shaft fractures show good progress with non-operative treatment, and we typically observe a progressive decrease in fracture site mobility during cast changes. Clinical consolidation is a more important parameter in the first few weeks, as at this point, radiological parameters are not yet available. The fracture heals in 6 to 10 weeks (David). In comminuted fractures, the healing time is longer, averaging 11 weeks, and 12 weeks for transverse fractures (Sarmiento). Surgical treatment should be indicated after up to 16 weeks, but this period can be extended if radiological progression toward consolidation is observed on serial radiological follow-ups every 4 weeks. What is the incidence of joint stiffness in the shoulder and elbow when comparing locked intramedullary nails with compression plates? Patients operated on with plates have lower rates of shoulder pain. However, when plates are placed in fractures near the metaphyseal region of the elbow, they have a higher incidence of pain in this region. Patients operated on with anterograde locked intramedullary nails have a higher incidence of shoulder impingement, pain, and stiffness.