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Radial Nerve Disruption Following Application of a Hinged Elbow External FixatorA Report of Three Cases
Gregor Baumann, MD1; Ladislav Nagy, MD1; Bernhard Jost, MD1
1 Department of Orthopaedics, University Hospital Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. E-mail address for B. Jost: bernhard.jost@balgrist.ch
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedics, University Hospital Balgrist, Zurich, Switzerland

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 May 18;93(10):e51 1-4. doi: 10.2106/JBJS.J.00436
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A hinged or articulated elbow external fixator is recommended for patients with elbow instability1, as a protective device following extensive capsular release of elbow contractures2, after ligamentous reconstruction3, for distraction interposition arthroplasty4, and in the management of complex elbow fracture-dislocations5. The hinged external fixator permits early postoperative elbow mobilization while maintaining elbow stability. There is a growing recognition of the value of and indications for articulated external fixation of the elbow6, despite the possibility of serious complications. Cheung et al.6 classified complications related to hinged external fixators of the elbow as major and minor. Minor complications, which occurred in 15% of patients, included local erythema and nonpurulent pin-site drainage lasting longer than five days and the need for skin release to decrease tension adjacent to the pins. Major complications, which occurred in 10% of patients, included purulent pin-site drainage, fixator malalignment, pin loosening, and deep infection. Although cases of transient radial nerve palsy are described in the literature1,7, to the best of our knowledge no permanent radial nerve palsy has been documented following application of a hinged external fixator. We present three cases of radial nerve palsy due to complete nerve disruption after application of a hinged external fixator for the treatment of complex elbow injuries.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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