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Archives of Orthopaedic and Trauma Surgery

, Volume 130, Issue 4, pp 519–522 | Cite as

The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases

  • Marko Bumbaširević
  • Aleksandar Lešić
  • Vesna Bumbaširević
  • Goran Čobeljić
  • Ivan Milošević
  • Henry Dushan E. AtkinsonEmail author
Trauma Surgery

Abstract

Patients and 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.

Keywords

Humerus fracture Radial nerve palsy Non-operative Expectant treatment 

Notes

Conflict of interest statement

No competing interest or funding declared.

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Marko Bumbaširević
    • 1
  • Aleksandar Lešić
    • 1
  • Vesna Bumbaširević
    • 2
  • Goran Čobeljić
    • 3
  • Ivan Milošević
    • 1
  • Henry Dushan E. Atkinson
    • 4
    • 5
    Email author
  1. 1.Clinical Centre for SerbiaInstitute for Orthopaedic Surgery and TraumatologyBelgradeSerbia
  2. 2.Clinical Centre of SerbiaInstitute for AnesthesiologyBelgradeSerbia
  3. 3.Institute for Orthopaedic SurgeryBelgradeSerbia
  4. 4.Department of Trauma and Orthopaedics, University College London Medical SchoolNorth Middlesex University HospitalLondonUK
  5. 5.LondonUK

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