Nerve monitoring during proximal humeral XXXX fixation: what have we learned?

@entity1 @entity129 @entity66 @entity174 @entity6 @entity16 @entity128 @entity5300 @entity1897 @entity2701 @entity130
BACKGROUND: The incidence of @entity16 after proximal humerus @entity174 is variable, ranging from 6.2% to as much as 67%. However, it is unclear what factors might contribute to these injuries or whether they can be prevented by intraoperative nerve monitoring. QUESTIONS/PURPOSES: Therefore, using intraoperative nerve monitoring, we assessed the incidence, pattern of nerve involvement, and predisposing factors for @entity128 before and during shoulder @entity174 fixation. @entity1 AND METHODS: We used continuous intraoperative monitoring of the brachial plexus in 37 @entity1 undergoing open operative treatment of proximal humerus @entity174 . Impending intraoperative compromise of nerve function was signaled by sustained neurotonic EMG activity or greater than 50% amplitude attenuation of transcranial electrical motor evoked potentials (MEPs) (or both). When a nerve alert occurred, current surgical activity and arm and retractor position were recorded and adjustments were made to relieve @entity2701 . RESULTS: The intraoperative affected nerves included axillary (46%), combined (mixed @entity5300 ) (23%), radial (23%), musculocutaneous (4%), and ulnar (4%). Postoperatively, three @entity1 had @entity129 , which fully resolved within 3 weeks of surgery. Low body mass index (BMI) (22.7    2.8), history of cervical @entity66 , @entity6 , and delay in surgical treatment (14    2.9 days from @entity130 ) were associated with an increased incidence of @entity129 . CONCLUSIONS: Our observations suggest transcranial electrical MEPs are sensitive indicators of impending @entity130 to the @entity1897 (or both) during open operative treatment of proximal humerus @entity174 . The use of intraoperative nerve monitoring during these procedures may be considered for the prevention of @entity128 , particularly in @entity1 with underlying cervical @entity66 , low BMI, @entity6 , and/or delay in surgical treatment greater than approximately 14 days. LEVEL OF EVIDENCE: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
