Use of Ultrasound in Detection and Treatment of Nerve Compromise in a Case of Humeral Lengthening

S. Robert Rozbruch, MD
S. Robert Rozbruch, MD

Chief, Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery
Director, Limb Salvage and Amputation Reconstruction Center (LSARC), Hospital for Special Surgery
Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Clinical Orthopaedic Surgery, Weill Cornell Medical College
President Emeritus, Limb Lengthening & Reconstruction Society

Craig Fryman, BS
Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery

Daniel Bigman, PA
Limb Lengthening and Complex Reconstruction Service, Department of Orthopedic Surgery, Hospital for Special Surgery

Ronald Adler, PhD, MD
Chief, Division of Ultrasound and Body CT, Radiology and Imaging, Hospital for Special Surgery
Attending Radiologist, Hospital for Special Surgery
Attending Radiologist, New York Presbyterian Hospital
Professor of Radiology, Weill Cornell Medical College
Research Scientist, Hospital for Special Surgery


The development of iatrogenic nerve lesions during and following limb lengthening procedures present a challenge to orthopedic surgeons. Early treatment of nerve damage is critical in salvaging full function of the nerve. Precise location of damage, however, must be determined in order to appropriately administer treatment. We report a patient with a short humerus caused by a growth arrest undergoing a 7-cm lengthening who developed a neurapraxic injury of the radial nerve. Nerve compromise was noted 1 month into the lengthening program. Nerve conduction studies and electromyography could not be used to determine the precise site of injury. Likewise, magnetic resonance imaging and computed tomography were contraindicated and inconclusive, respectively, due to the presence of a metallic external fixation device. High-resolution ultrasonography (US) findings, however, correlated with our clinical examination of the patient's radial nerve function and permitted identification of the precise site of nerve involvement. Treatment was administered by removing a causative half-pin. Several days following treatment, nerve function returned to normal. There are a limited number of articles in the literature regarding nerve injuries associated with limb lengthening and their corrective treatments. The outcome of this case underscores the usefulness of US over various other diagnostic techniques under certain circumstances.

This article appears in HSS Journal: Volume 7, Number 1.
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About the HSS Journal
HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.


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