Ultrasound-guided radial nerve mapping during external fixation for elbow trauma: a case series of 13 patients

External fixation is used in damage control surgeries for severe elbow trauma. However, complications such as pin-site fractures, pin-site infections, and radial nerve injury can occur. Preoperative ultrasound guidance facilitates radial nerve identification and may reduce the risk of nerve injury during surgical pin placement. We aimed to evaluate the clinical use of ultrasound-guided radial nerve mapping during external fixation for severe elbow trauma and assess the occurrence of postoperative radial nerve palsy.

This retrospective case series included 13 patients who underwent external fixation for severe elbow trauma between April 2015 and October 2023. Patients with active infections, hinged external fixators, external fixators used as definitive treatment, or nerve palsy after injury were excluded. The course of the radial nerve was marked using ultrasonography prior to pin insertion, and pins were inserted via a small skin incision. Complications related to external fixation were assessed.

The median patient age was 65 years (IQR, 47-72 years) and the median follow-up duration was 700 days (IQR, 475-742 days). None of the patients had radial nerve palsy or pin-site infection. One patient had a pin-site fracture. All patients successfully underwent secondary surgery within a median of 10 days (IQR, 7-13 days) after the external fixation.

There were no cases of radial nerve palsy detected with ultrasound-guided radial nerve mapping after external fixation for severe elbow trauma.