Postoperative Radialisparese

Abstract

Radial nerve palsy is a rather frequent complication caused by an accident as well as by surgery of the humerus. As a primary, i.e., accidental lesion, its incidence as stated in the literature is up to 30%, primarily fractures in the distal diaphyseal half. Secondary, i.e., surgically induced, nerve lesions surprisingly are reported with a similar frequency, though recently the incidence only approaches some 3%. Experts continue to argue over the timing for operative revision. Many authors rely on spontaneous recovery of the nerve as maintained by L. Boehler in the early 1960s, but this theory was rendered obsolete by the technical achievements of microsurgery and the patients' economic constraints. Other authors are afraid of accidentally damaging the nerve by revision surgery. The stand we take in this controversy is instant revision surgery both for accidental lesions as well as uncompromisingly for those incurred during surgery when the surgeon had not explored the nerve far enough to preserve it during the operation. Three exemplary cases are reported, one of them submitted for an expert's opinion because of an alleged mistake on the part of the doctor. Forensic responsibility has to match actual indication principles and the specific technique applied.

Primary Exploration of Radial Nerve is Not Required for Radial Nerve Palsy while Treating Humerus Shaft Fractures with Unreamed Humerus Nails (UHN)

“…As radial nerve palsy remission is often not complete, but at a rate of 90%, other authors argue - due to the remaining 10% - for rapid surgical exploration [7,19,25]. As advantages for early revision, its advocates list easier detection and better assessment of the nerve.…”

Reconstruct the proximal radius with iliac graft and elastic intramedullary nail fixation after tumor resection

“…Radial nerve dysfunction is a common sequela of a diaphyseal humeral fracture and proximal radius fracture, or the surgery to repair them [ 36 , 37 ]. Surgery places the radial nerve at risk usually because of traction, but sometimes due to pressure from a retractor, the exposure, or damage from a drill or implant [ 38 ].…”

Humerus Shaft Fractures - Where Are We Today?

“…In this context, the question arises of which fracture fixation method is associated with the greatest probability of radial nerve damage. Studies on this topic with the relevant level of evidence do not exist and data from isolated retrospective surveys vary from 0 to 10% postoperative radial palsy regardless of the stabilization technique (8).…”