Radial nerve palsy associated with high-energy humeral shaft fractures.
OBJECTIVE
To determine whether the radial nerve should be explored when there is a complete sensory and motor deficit after a high-energy fracture of the humeral diaphysis.


METHODS
Twenty-four patients aged 16 years or older with a high-energy, diaphyseal fracture of the humerus and complete motor and sensory radial nerve palsy were reviewed retrospectively. Eleven fractures were open-6 of these were part of a very complex upper-extremity injury (multiple ipsilateral fractures in 3 patients and near amputation in 3). All 11 patients with open fractures and 3 of 13 patients with closed injuries had radial nerve exploration.


RESULTS
All 6 patients with a transected radial nerve had an open humerus fracture and were part of a complex upper-extremity injury. Five of 6 had primary repair of the radial nerve, and none recovered. All 8 intact explored nerves and 9 of 10 unexplored nerves recovered; the only nonrecovery occurred in a patient treated with closed intramedullary rod fixation who may have had iatrogenic nerve injury. The average time to initial signs of recovery was 7 weeks (range, 1-25 weeks). The average time to full recovery was 6 months (range, 1-21 months).


CONCLUSIONS
Transection of the radial nerve is usually associated with open fractures of the humerus that are part of a very complex upper-extremity injury. The results of primary nerve repair in this circumstance are poor, likely related to an extensive zone of injury and the need for nerve grafting. Intact nerves and nerve palsies that are part of a closed fracture nearly always recover, even after high-energy injuries. Because the first signs of nerve recovery and complete recovery of the nerve can be quite delayed, patience is merited before considering tendon transfers.
Ring
David
D
Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Ambulatory Care Center 525, 15 Parkman Street, Boston, MA 02114, USA.
Chin
Kingsley
K
Jupiter
Jesse B
JB
D000293:Adolescent; D000328:Adult; D004576:Electromyography; D005260:Female; D005596:Fractures, Closed / Q000150:complications* / Q000601:surgery; D005597:Fractures, Open / Q000150:complications* / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000150:complications* / Q000601:surgery; D008297:Male; D009431:Neural Conduction; D011826:Radial Nerve / Q000293:injuries / Q000601:surgery*; D020425:Radial Neuropathy / Q000209:etiology* / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome