Approach to radial nerve palsy caused by humerus shaft fracture: Is primary exploration necessary?

Retrospective case series with one year follow-up after radial nerve palsy associated with humeral fractures

“…In the case of acute primary radial nerve palsy open reduction facilitates fracture treatment and enables simultaneous exploration of the radial nerve to determine the extent and the type of lesion [1,7,18]. It has been postulated that earlier surgical intervention with ORIF leads to earlier recovery of radial nerve palsy [21,22].…”

“…Due to different methods of fixation for humeral shaft fractures regarding closed or open fracture reduction, it is necessary to decide if early exploration in primary radial nerve palsy is indicated [4,6]. Thus open exploration facilitates fracture reduction and reduces damage by bony fragments and entrapment of the nerve [4,7]. Open or closed reduction of humeral shaft fractures is accompanied by resulting secondary radial nerve palsy in 6-12 % [8].…”

Primary exploration for radial nerve palsy associated with unstable closed humerus shaft fracture

“…[2] The treatment of radial nerve palsy caused by the closed humeral shaft fracture is a matter of debate. [1,3] Some authors recommend early exploration of the radial nerve and open reduction and fixation of the fracture, whereas others advocate conservative treatment of the fracture and a strategy of expectant management for radial nerve palsy.…”

“…[4][5][6][7][8][9][10] Korompilias et al recommended [16][17][18] weeks of expectant management, followed by surgical intervention due to high rate of spontaneous recovery of radial nerve after closed humeral shaft fracture. [2] The treatment of closed humeral shaft fracture itself is controversial. There is no sufficient evidence available to ascertain whether surgical intervention of humeral shaft fractures results in a better or worse outcome than no surgery.…”

Editorial: Radial nerve

“…13 On the other hand, Wang et al reported iatrogenic radial nerve palsy in 30 of 707 surgically treated patients with humeral shaft fractures (an incidence of approximately 4.2%) over a period of 10 years. 14 Shoulder girdle injuries are usually associated with multiple nerve palsies including the radial nerve. De Laat et al, in a study that involved 101 patients with shoulder dislocation and humeral neck fracture, reported axonal loss (i.e., at least an axonotmetic injury) on electromyographic evaluation of the radial nerve in 22% of cases, whereas 29% had axonal loss in the suprascapular nerve and 37% in the axillary nerve.…”