{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:02:02Z","timestamp":1790654522602,"version":"4.1.0"},"reference-count":7,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,11,17]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Holstein-Lewis fractures are spiral fractures in the distal third of the humeral shaft, which carry increased risk of radial nerve palsy compared with other humeral shaft fractures; these fractures are usually managed conservatively. However, there is no case in the existing literature that describes the management of Holstein-Lewis fractures with radial nerve entrapment in a patient with a history of total elbow arthroplasty (TEA). Here, we present the first documented case of a complex revision elbow arthroplasty for Holstein-Lewis fracture with delayed onset radial nerve entrapment after a skydiving injury. In patients with Holstein-Lewis fractures who underwent previous TEA, we identify the increased risk of nerve entrapment due to loose metallosis surrounding the fracture site and discuss the operative challenges that these rarer cases pose. We also necessitate the early monitoring of suspected neurapraxia in these patients and highlight the prognostic benefits of performing timely nerve exploration and operative intervention.<\/jats:p>","DOI":"10.1136\/bcr-2025-268469","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T19:00:29Z","timestamp":1768590029000},"page":"e268469","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Complex revision elbow arthroplasty for periprosthetic Holstein-Lewis fracture with delayed onset radial nerve entrapment after skydiving injury"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9966-2252","authenticated-orcid":false,"given":"Karthik","family":"Saravanan","sequence":"first","affiliation":[{"name":"School of Medicine and Biomedical Sciences, University of Oxford Queen\u2019s College, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Kristian","family":"Woods","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leela","family":"Sayed","sequence":"additional","affiliation":[{"name":"Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher Paul","family":"Little","sequence":"additional","affiliation":[{"name":"Upper Limb, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"2026011611002343000_19.1.e268469.1","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.88B11.17634"},{"key":"2026011611002343000_19.1.e268469.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2006.04.130"},{"key":"2026011611002343000_19.1.e268469.3","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/j.jhsa.2024.03.013","article-title":"Radial Nerve Palsy in the Setting of Humeral Shaft Fracture","volume":"49","author":"Weisberg","year":"2024","journal-title":"J Hand Surg Am"},{"key":"2026011611002343000_19.1.e268469.4","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.2106\/00004623-196345070-00004","article-title":"Fractures of the Humerus with Radial-Nerve Paralysis","volume":"45","author":"Holstein","year":"1963","journal-title":"J Bone Joint Surg"},{"key":"2026011611002343000_19.1.e268469.5","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/BOT.0b013e31818915bf","article-title":"The Holstein-Lewis humeral shaft fracture: aspects of radial nerve injury, primary treatment, and outcome","volume":"22","author":"Ekholm","year":"2008","journal-title":"J Orthop Trauma"},{"key":"2026011611002343000_19.1.e268469.6","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.ajem.2015.06.045","article-title":"Holstein Lewis humerus fracture","volume":"34","author":"Acuna","year":"2016","journal-title":"Am J Emerg Med"},{"key":"2026011611002343000_19.1.e268469.7","article-title":"Integrated Physical Therapy in a Unique Case of Holstein-Lewis Fracture With Radial Palsy: A Case Report","volume":"16","author":"Akhuj","year":"2024","journal-title":"Cureus"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-268469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T19:00:30Z","timestamp":1768590030000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-268469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":7,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,16]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-268469"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-268469","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}