title: The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases.
abstract: METHODS
  This single center retrospective study reviews the management and outcomes of 117 consecutive patients with humeral shaft fractures and associated radial nerve palsy (RNP) treated over a 20-year period (1986-2006). A total of 101 fractures were managed conservatively and 16 fractures underwent external fixation for poor bony alignment. Sixteen grade 1 and 2 open fractures underwent wound toileting alone. No patients underwent initial radial nerve exploration or opening of the fracture sites.
  
  
  RESULTS
  All patients achieved clinical and radiological bony union at a mean of 8 weeks (range 7-12 weeks). There were no complications or pin tract infections in the operated patients. A total of 111 cases had initial spontaneous RNP recovery at a mean of 6 weeks (range 3-24 weeks) with full RNP recovery at a mean of 17 weeks (range 3-70 weeks) post-injury. Fourteen patients had no clinical/EMG signs of nerve activity at 12 weeks and 6 subsequently failed to regain any radial nerve recovery; 2 had late explorations and the lacerated nerves underwent sural nerve cable neurorraphy; and 4 patients underwent delayed tendon transposition 2-3 years after initial injury, with good/excellent functional outcomes.
  
  
  CONCLUSIONS
  Humeral fractures with associated RNP may be treated expectantly. With low rates of humeral nonunion, 95% spontaneous nerve recovery in closed fractures and 94% in grade 1 and 2 open fractures, one has the opportunity of waiting. If at 10-12 weeks there are no clinical/EMG signs of recovery, then nerve exploration/secondary reconstruction is indicated. Late tendon transfers may also give good/excellent functional results.
authors: Clinical Centre for Serbia, Institute for Orthopaedic Surgery and Traumatology, Visegradska 26, Belgrade, Serbia.
authors: Marko
authors: M
authors: Bumbasirević
authors: Aleksandar
authors: A
authors: Lesić
authors: Vesna
authors: V
authors: Bumbasirević
authors: Goran
authors: G
authors: Cobeljić
authors: Ivan
authors: I
authors: Milosević
authors: Henry Dushan E
authors: HD
authors: Atkinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011826:Radial Nerve / Q000293:injuries*; D020425:Radial Neuropathy / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult