title: Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome.
abstract: BACKGROUND
  The incidence of radial nerve injury after humeral shaft fractures is on average 11.8% (Shao et al., J Bone Jt Surg Br 87(12):1647-1652, 2005) representing the most common peripheral nerve injury associated with long bone fractures (Korompilias et al., Injury, 2013). The purpose of this study was to analyze our current policy and long-term outcome, regarding surgically treated humeral shaft fractures in combination with radial nerve palsy.
  
  
  METHODS
  We retrospectively analyzed the data of patients with surgically treated humeral shaft fractures from 01/01/2003 to 28/02/2013. The analysis included fracture type, soft tissue injury regarding closed and open fractures, type of fixation, management, and outcome of radial nerve palsy.
  
  
  RESULTS
  A total of 151 humeral shaft fractures were fixed in our hospital. In 20 (13%) cases, primary radial palsy was observed. Primary nerve exploration was performed in nine cases. Out of the 13 patients with follow-up, 10 showed a complete, 2 a partial, and 1 a minimal nerve recovery. Two of them underwent a revision procedure. Secondary radial nerve palsy occurred in 9 (6%) patients postoperatively. In five patients, the radial nerve was not exposed during the initial surgery and, therefore, underwent revision with nerve exploration. In all 5, a potential cause for the palsy was found and corrected as far as possible with full recovery in 3 and minimal recovery in one patient. In four patients with exposure of the nerve during the initial surgery, no revision was performed. All of these 4 showed a full recovery.
  
  
  CONCLUSIONS
  Our study showed an overall rate of 19% radial nerve palsy in surgically treated humeral shaft fractures. Most of the primary palsies (13%) recovered spontaneously, and therefore, nerve exploration was only exceptionally needed. The incidence of secondary palsy after surgery (6%) was high and mainly seen after plate fixation. In these cases, we recommend early nerve exploration, to detect and treat potential curable neural lesions.
authors.affiliation: Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland. tobias.r.schwab@gmail.com.
authors.forename: T R
authors.identifier: http://orcid.org/0000-0003-2985-0642
authors.initials: TR
authors.lastname: Schwab
authors.affiliation: Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland.
authors.forename: P F
authors.initials: PF
authors.lastname: Stillhard
authors.affiliation: Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Schibli
authors.affiliation: Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Furrer
authors.affiliation: Kantonsspital Graubünden, Loestrasse 170, 7000, Chur, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Sommer
mesh_terms: D000328:Adult; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000601:surgery*; D006811:Humerus / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D011826:Radial Nerve; D020425:Radial Neuropathy / Q000150:complications / Q000601:surgery*; D020127:Recovery of Function; D016896:Treatment Outcome
keywords: Humeral shaft fracture; Internal fixation; Primary radial nerve palsy; Secondary radial nerve palsy