Radial nerve exploration and nerve grafting using autologous graft and AxoGen AVANCE nerve allograft


Subscribe to get full access to this operation and the extensive Upper Limb & Hand Surgery Atlas.


Learn the Radial nerve exploration and nerve grafting using autologous graft and AxoGen AVANCE nerve allograft surgical technique with step by step instructions on OrthOracle. Our e-learning platform contains high resolution images and a certified CME of the Radial nerve exploration and nerve grafting using autologous graft and AxoGen AVANCE nerve allograft surgical procedure.

The radial nerve is vulnerable to injury as it courses around the humerus in the spiral groove. Most radial nerve injuries associated with low energy fractures are of a low-grade, typically a neurapraxia with some degree of demyelination affecting the large myelinated fibres (prolonged conduction block) or with some partial and minor axon disruption (mixed nerve injury). These injuries usually recover fully in 6-12 weeks without surgical intervention for the nerve injury. Delayed recovery may necessitate exploration and decompression at the lateral inter-muscular septum.

One should be cautious when making such a diagnosis in the setting of a high energy injury, when there is neuropathic pain or when there is deterioration after intervention. In a case with intact function then loss after closed reduction and casting, one should anticipate that the nerve has been caught in the fracture and urgent exploration is warranted. At best the nerve will be swollen with haematoma compression at the lateral septum and decompression will improve the situation and the chance of recovery. When the onset of palsy follows surgical intervention with ORIF one should assume that there has been a direct nerve injury. The mechanism may be traction, entrapment under a plate, direct injury with a drill or screw. There is little merit in waiting and typically the pre-operative assessment is inadequate to confirm that intra-operative nerve trauma has occurred and unnecessary delay ensues whilst neurophysiology is requested.

The case presented was referred to me at 8 months following fixation of a distal humeral fracture with a direct posterior approach and precontoured locking plates applied medially and posterolaterally to stabilise the fracture. Exploration confirmed injury to the radial nerve and the branch to brachioradialis from a drill bit with nerve rupture. A long gap of 7cm had resulted and the options for reconstruction are discussed.

An AVANCE processed nerve allograft was selected for the main radial nerve trunk as a pain management and sensory recovery strategy with autologous sensory nerve graft from the posterior cutaneous nerve of the forearm to the branch to brachioradialis. The case was combined with a distal pronator teres tendon transfer to the extensor carpi radialis brevis and nerves transfers from the median nerve to the posterior interosseus nerve for digit extension. This strategy was selected due to the timing of presentation and the low chance of any meaningful recovery through a long segment autologous graft at this stage.


Author: Dominic Power FRCS Orth, Consultant Hand and Peripheral Nerve Surgeon

Institution: Peripheral Nerve Injury Service, Queen Elizabeth Hospital, Birmingham, UK

  • Each operation and the questions associated become a named course in the CPD section
  • The operative technique itself is read as a lesson as is any company implant information if this is being assessed.
  • You’ll need to tick the box to confirm this has been done and can do this immediately if you have already read the op tech.
  • The vast majority of operations have a 10-15 MCQ quiz covering all aspects of the decision making and the technique
  • There are four possible answers of which one is correct (or on occasion more correct) than the others.
  • There are additional quiz modules on the surgical steps, the implants and problem cases being added continually
  • The course is completed once all the lessons are read and quizzes submitted and passed.
  • On successful completion of each quiz you will receive validated CPD points that add to the certificate in your CPD folder.
  • Your dashboard also will contain a record of the time you have spent logged onto and using the site.
  • The timer suspends after 5 minutes though if there is no activity.
  • When you restart you will resume at the same point in the module.
  • Once you have completed each quiz you will need to feedback on the module first then click “submit” and your paper will be marked.
    The pass mark is 75%.
  • If you fall below this level you will be directed back to re-read the slides where you’ve tripped up.
  • Once these have been read you can re-do just the questions you failed on.
  • Once you have passed the quiz you can return at a future stage & resit .

CPD Points:

  • Operation Quiz – 1 CPD point
  • Surgical steps Quiz – 1/4 CPD point
  • Implants Quiz – 1/4 CPD point
  • Problem case Quiz – 1/2 CPD point

One CPD point equates to one hour of academic activity


Welcome to the Professional Development question section. The objective of taking these tests is to demonstrate that you have understood all aspects of the assessment and management of patients requiring surgical intevention. On successful completion you will receive a certificate accredited by both the Royal College of Surgeons of both England and Edinburgh as well as the British Orthopaedic Association.

Our content is designed for both Surgeons in independent practice and Surgeons in training.


  • Did you find this technique helpful?
  • YesNo

Lessons Status


Logo Logo Logo Logo Logo Logo Logo

Associates & Partners

Logo Logo Logo Logo Logo Logo