Review of Literature of Radial Nerve Injuries Associated with Humeral Fractures—An Integrated Management Strategy

Abstract

BackgroundRadial nerve palsy associated with fractures of the shaft of the humerus is the most common nerve lesion complicating fractures of long bones. However, the management of radial nerve injuries associated with humeral fractures is debatable. There was no consensus between observation and early exploration.Methods and FindingsThe PubMed, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, CINAHL, International Bibliography of the Social Sciences, and Social Sciences Citation Index were searched. Two authors independently searched for relevant studies in any language from 1966 to Jan 2013. Thirty studies with 2952 humeral fractures participants were identified. Thirteen studies favored conservative strategy. No significant difference between early exploration and no exploration groups (OR, 1.03, 95% CI 0.61, 1.72; I2 = 0.0%, p = 0.918 n.s.). Three studies recommend early radial nerve exploration in patients with open fractures of humerus with radial nerve injury. Five studies proposed early exploration was performed in high-energy humeral shaft fractures with radial nerve injury.ConclusionsThe conservative strategy was a good choice for patients with low-energy closed fractures of humerus with radial nerve injury. We recommend early radial nerve exploration (within the first 2 weeks) in patients with open fractures or high-energy closed fractures of humerus with radial nerve injury.

Humerus shaft fracture associated with traumatic radial nerve palsy: An international survey among orthopedic trauma surgeons from Latin America and Asia/Pacific

“…9 On the other side, open fractures and high-energy trauma mechanism are generally considered for operative management because of the elevated rate of nerve entrapment or transection. 5,6 The current study provides important information about attitudes of orthopedic surgeons all over the world regarding the treatment of humeral shaft fracture associated with traumatic radial nerve palsy. Although initial conservative management has shown good fracture healing and high rate of nerve recovery, respondents overwhelmingly believe that fracture fixation is the best treatment in these cases, clearly demonstrating a change of concept, with gradual abandonment of nonsurgical treatment.…”

“…Early exploration of the radial nerve has been advocated in cases of open humerus fracture or when surgical treatment is elected for other reasons. 1,2,5 Another source of confusion to deliberate between to explore and not a traumatic radial nerve palsy associated with a humerus shaft fracture is the complete lack of objective clinical and radiological factors. Anecdotally, highenergy humerus fractures and extensive local soft-tissue damage have been considered indications for early exploration and repair of a radial nerve lesion.…”

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

“…The overall incidence of radial nerve palsy following humeral shaft fractures is about 2-18 %, in mean 12 % [4,5]. 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].…”

Functional and radiological outcome of intramedullary interlocking nail in the treatment of fracture shaft of humerus

“…The study was conducted on all the 25 patients with our proposed surgery and they were assessed radiologically and clinically for signs of fracture healing during each visit at 4,8,12,16,20 weeks. Shoulder function is assessed using Constant murley scoring system.…”