Most of the site will reflect the ongoing surgical activity of Prof. Munir Elias MD., PhD. with brief slides and weekly activity. For reference to the academic and theoretical part, you are welcome to visit
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24-DECEMBER-2011 AHMAD MAJEED SALEH 29 YEARS
INJURY TO THE RADIAL NERVE LOWER THIRD OF THE LEFT ARM.
patient came from Iraq-Baghdad 03-September-2011
complaining of complete drop left wrist and hand
after explosion 28-August-2011. He came with a
sling and POP above the left elbow with X-rays
showing chip fracture of the left humerus lower
third lateral aspect.
examination, the patient had complete non
function of the left radial nerve including the
brachioradialis muscle with anaesthesia of the
left radial nerve territory. The patient was
given nonsteroids and medications to improve the
patient then came 21-September-2011 with ECS
confirming that there is complete axonal damage
to the left radial nerve. The patient was
advised to wait for another month and he came
25-October-2011 with new ECS confirming
signs of reinnervation of the left brachioradial
muscle. The patient was advised to wait another
2 months and he came 21-December-2011 with new
ECS confirming that, there is no changes in the
recovery process. Surgical exploration was
Projection incision upon the
affected area of the left radial nerve. The
distal part of the radial nerve was isolated
between the brachialis and radiobrachial
muscles. The proximal part of the radial nerve
above the affected site was identified. Using
ISIS Inomed Neurosxplorer the distal part of the
nerve was studied. Upon stimulation with 2mA DNS
the brachioradial muscle was responding well.
The other muscles below this level were showing
very weak response upon stimulation with 15 mA,
which could be explained by retrograde
stimulation of other muscles. Dissection down
and up from the distal part was proceeded until
it was clear that the branch to the
radiobrachial muscle was emerging above the
neuroma. It was anatomically preserved and
separate check for its function showed good
response of the brachioradial muscle. Studying
the radial nerve at the neuroma level and below
showed no response. The neuroma was cut. until
the distal and proximal stumps showed good
fibrillary structure. The gap was 17 mm in
length. Putting the elbow in slight flexion, end
to end anastamosis was achieved without tension.
Using 4 zero and 6 zero nylon the stumps were
stitched with good cooptation.
The rounded shrapnel was
removed from the left heel under the control of
closure of the wounds. Smooth postoperative
patient came 01-August-2013 for evaluation,
telling that he stopped medication the last 2
months. The patient has full motor recovery of
the left affected limp. He could dorsiflex the
left wrist and extend the fingers. There was a
small spot of anaesthesia in the web of the
thumb of the left hand.
If to give
estimation of the degree of recovery, then it
will be 95%, which is excellent for radial nerve
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The patient had injury tot eh left radial nerve
with shrapnel's and chip fracture of the bone,
reflecting the severity of the injury. Early
intervention was not recommended, because there
was swelling and a cast in the injured area.
The recovery of the left brachioradial muscle
could be explained by the emergence of its
neural supply above the damaged area.
This was confirmed by the operative findings.
Schematic representation of the lesion. Notice the neuroma is under
the emergence of the brachioradial muscle branch.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .