XXXX associated with humeral shaft @entity174 . Is the energy of @entity130 a prognostic factor?

@entity1 @entity66 @entity174 @entity130 @entity4542
BACKGROUND: @entity4542 associated with humeral shaft @entity174 is the most @entity66 complicating @entity174 of long bones. The purpose of the study was to review the outcome of surgical management in @entity1 with low energy and high energy @entity4542 after humeral shaft @entity174 . METHODS: Eighteen @entity1 were treated operatively for a humeral shaft @entity174 with @entity4542 . The mean age was 32.2 years and the mean follow up time was 66.1 months (range: 30-104). The surgical management included @entity174 fixation with early nerve exploration and repair if needed. The @entity1 were divided in two groups based on the energy of @entity130 (low vs. high @entity130 energy). The prevalence of injured and unrecovered nerves and time to nerve recovery were analysed. RESULTS: Five @entity1 sustained low and 13 high energy @entity130 . All @entity1 with low energy @entity130 had an intact (4) or entrapped (1) radial nerve and recovered completely. Full nerve recovery was also achieved in five of 13 @entity1 with high energy @entity130 where the nerve was found intact or entrapped. Signs of initial recovery were present in a mean of 3.2 weeks (range: 1-8) for the low energy group and 12 weeks (range: 3-23) for the high energy group (p=0.036). In these @entity1 , the average time to full recovery was 14 and 26 weeks for the low and high energy @entity130 group respectively. Eight @entity1 with high energy @entity130 had severely damaged nerves and failed to recover, although microsurgical nerve reconstruction was performed in 4 cases. @entity1 with high energy @entity130 had a prolonged @entity174 healing time (18.7 weeks on average) compared to those with low energy @entity174 (10.4 weeks), (p=0.003). CONCLUSIONS: The outcome of the @entity4542 following humeral @entity174 is associated to the initial @entity130 . Palsies that are part of a low energy @entity174 uniformly recover and therefore primary surgical exploration seems unnecessary. In high energy @entity174 , neurotmesis or severe contusion must be expected. In this case nerve recovery is unfavourable and the @entity1 should be informed of the poor prognosis and the need of tendon transfers.
