The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases.
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.
Bumbasirević
Marko
M
Clinical Centre for Serbia, Institute for Orthopaedic Surgery and Traumatology, Visegradska 26, Belgrade, Serbia.
Lesić
Aleksandar
A
Bumbasirević
Vesna
V
Cobeljić
Goran
G
Milosević
Ivan
I
Atkinson
Henry Dushan E
HD
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