Infraclavicular Brachial Plexus Exploration Combined Radial Nerve Exploration for Iatrogenic Injury After Humeral Shaft Fixation

Abstract

Abstract Objectives Iatrogenic nerve injury is an uncommon but serious complication of humeral shaft fracture fixation and may result in severe functional impairment. While radial nerve palsy is the most frequently reported neurological complication, combined injuries involving the infraclavicular brachial plexus and its terminal branches are rare. This case report aims to present the surgical management and functional outcome of a delayed iatrogenic infraclavicular brachial plexus and radial nerve injury following humeral shaft fixation. Methods A 67-year-old female patient was referred one year after humeral shaft fracture fixation performed at another institution. Clinical examination revealed combined radial, median, and ulnar nerve dysfunction. Radiological evaluation demonstrated medial protrusion of a proximal screw and improper plate positioning. Revision surgery included infraclavicular brachial plexus exploration, removal of the protruding screw, posterior humeral exploration, primary epineurial repair of the radial nerve, and simultaneous tendon transfer procedures. Results Intraoperatively, the radial nerve was found to be entrapped beneath the plate and transversely split by the implant. Primary epineurial neurorrhaphy was performed, along with tendon transfers including pronator teres to extensor carpi radialis brevis, palmaris longus to extensor pollicis longus, and flexor carpi radialis to extensor digitorum communis. At one-year follow-up, significant recovery of median and ulnar nerve function was observed. Tendon transfers provided satisfactory restoration of wrist, finger, and thumb extension, enabling functional use of the affected upper extremity. Conclusion This case highlights the importance of proper surgical exposure and implant placement during humeral shaft fixation. In delayed iatrogenic nerve injuries, a multimodal reconstructive strategy combining nerve repair and tendon transfer can lead to meaningful neurological and functional recovery.