Radial nerve contrast fluoroscopy combined with ultrasound imaging for humeral shaft fracture.

Ultrasonography is an alternative method for detecting the nerve tract in real-time. However, bones and soft tissues can encounter imaging difficulties because of the occasional blockade. Humeral shaft fracture can be addressed using several approaches, including open plate fixation and intramedullary nailing. Nevertheless, these methods are associated with a risk of radial nerve injury due to the presence of nerve tracts around the middle part of the humeral shaft. Here, we present a patient who underwent intramedullary nail fixation in the beach-chair position converted into open plate fixation in the prone position based on the radial nerve course on preoperative fluoroscopic evaluation. Combined fluoroscopy and ultrasonography of the fracture site facilitated the detection of anatomical structure disruption around the nerve and the safe completion of surgery. The nerve delineation technique with contrast-enhanced radiographic effects can prevent the risk of nerve injury.