Transhumeral Anterior Radial Nerve Transposition to Simplify Anticipated Future Humeral Reconstruction

Anterior transhumeral radial nerve transposition has been described in the treatment of humeral shaft fracture to protect the nerve from implant irritation or callus entrapment. Transposing the radial nerve through a facilitating humeral defect also simplifies revision surgery should nonunion result. Here we describe a surgical technique for anterior transhumeral radial nerve transposition for complex humeral reconstruction when subsequent revision surgery is anticipated. Three cases are used for illustration: (1) revision of a total elbow arthroplasty with periprosthetic fracture; (2) revision of a total elbow arthroplasty after aseptic loosening from an allograft/prosthesis composite; and (3) septic humeral nonunion with substantial bone loss. These 3 patients underwent a total of 16 operations, 6 of which took place after the radial nerve transposition. Transhumeral radial nerve transposition allowed less worrisome dissection during revision surgery despite the multiple previous procedures. We advocate transhumeral radial nerve transposition when the duration and frequency of revisions is uncertain and the anticipated future revision may require a posterior, posterolateral, or anterolateral approach to the humerus.