Virtual Exploration Surgery by MRI Scan for High Suspicion of Iatrogenic Nerve Insult

Ron Batash 1 Evgenia Cherniavsky 2 Ronen Debi 1 Dan Grinberg 1 Omri Lubovsky 1 Shiran Elmaleh 1 Yeshaiau Benedict 1
1Orthopedic Surgery, Barzilai Medical Center, Israel
2Radiology, Barzilai Medical Center, Israel

PURPOSE: To demonstrate the use of MRI as a virtual explorative surgery, in orthopedic cases with suspected nerve injury.

Material and methods: case study of a twenty three year old female patient admitted with a multi-fragmented left diaphyseal humeral fracture after a fall. The patient was operated with an Intra Medullary Nail fixation and began physiotherapy. After surgery, motor weakness and radial paresthesias were noticed. Due to a suspicion for radial nerve injury, an explorative surgery was considered. An expert neurosurgeon recommended an MRI scan instead of explrative surgery.

RESULTS: The MRI scan revealed an intact and continuous radial nerve along the left humerus. At follow up after 6 months, the patient demonstrated significant improvement in gross motor and sensation along the radial nerve. After 8 months from surgery normal sensation and motor function were reported.

CONCLUSION: This case shows the usefulness of an MRI scan for demonstration of neurovascular complexes and damage. The fact that an MRI scan revealed an intact radial nerve, suggests that it may be used as a diagnostic tool and considered as a virtual explorative surgery.

Ron Batash
Ron Batash