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

Abstract

Background:Today, humerus nails have become the surgical method of choice in the treatment of humerus shaft fractures. Whether or not the radial nerve should be intraoperatively examined by default in case of primary paresis is currently under discussion.Patients and Methods:Clinical findings from 38 patients with humeral shaft fractures surgically treated with unreamed humerus nail (UHN) at the Department of Accident Surgery, University Clinics Bonn, Germany, between 2000 and 2003 were retrospectively assessed. Constant Score was applied for evaluation of functional results.Results:In 40% of patients, primary radial nerve paresis was present. This was especially common after high energy trauma (e.g. traffic accident) and significantly increased in fractures of the middle third. In 93% of cases, spontaneous remission of motor and sensory loss was observed. No iatrogenic radial nerve impairment occurred.Conclusion:Due to the high rates of spontaneous remissions of radial nerve palsy after treatment with UHN in humerus shaft fractures, primar exploration of the radial nerve does not appear to be necessary.

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

“…Total recovery was observed in 82.4 % of our patients. Apart from shorter time of recovery among secondary radial nerve palsy and type A fractures our findings seem to be consistent with those described in current literature [1,6,12,21].…”

“…About 50 % of humeral shaft fractures are associated with high-energy trauma [12][13][14]. Studies by Venouziou et al…”

“…Both, ORIF and IN are well-established procedures with high rates of 85-93 % of recovery following primary radial nerve palsy [12,[17][18][19][20][21]. 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].…”

“…Time to recovery of primary and secondary radial nerve palsy depends on trauma mechanism, fracture type as well as the surgical management [3,6,12,19,21,24]. Shao et al published that the rate of spontaneous nerve recovery after secondary radial palsy was similar to that of primary radial palsy with an average time of onset of 7.3 weeks (2 weeks-6.6 months), the time of full recovery was reported with 6.1 months (3.4-12 months) [1].…”

Treatment of Humeral Shaft Fractures

“…Another retrospective review of thirtyeight cases of radial nerve palsies mirrored these findings, with 58% (twenty-two cases) occurring in the middle third of the shaft, 13% (five cases) occurring in the distal third of the shaft, 11% (four cases) occurring in the proximal third of the shaft, and 16% (seven cases) not specified 49 .…”