Complications and Outcomes Following Humerus Lengthening - An Illustrative: Case Report

Upper limb physeal injuries are dealt with differently simply because they do not hinder with the functional abilities of an individual. Humerus lengthening was first attempted in 1978 after which it encouraged many surgeons to safely perform the procedure. Radial nerve palsy occurring as a complication of humeral lengthening was a major concern.

We report a case of a 17-year-old girl with physeal arrest at the proximal physis of the humerus with etiology of post-trauma/post-infection. She presented with a shortening of 8 cm and restricted shoulder movements. We performed a lengthening of the humerus based on the principle of distraction osteogenesis. We used the paediatric limb reconstruction system to distract the corticotomy. However, postoperatively, she developed radial nerve palsy, despite our intraoperative precautionary measures. Distraction was started at 1mm/day. She then showed the progress of radial nerve recovery and full recovery was noted by 5 months post-operatively. The length of the distraction compression assembly had to be changed twice to longer sizes to accommodate the required amount of lengthening. After consolidation of regenerate was confirmed with serial radiographs, external fixator was removed. She was then maintained on a functional brace. We were able to achieve 8cm of lengthening following distraction, and the cosmetic appearance of the patient improved to the patient's and attenders' satisfaction.

Humeral lengthening can safely be performed. Careful insertion of the distal pins and performance of the corticotomy will ensure the safety of the radial nerve. Even if radial nerve palsy occurs after all precautions are taken, recovery can be expected.