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


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.


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.


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.


Humerus fracture Radial nerve palsy Non-operative Expectant treatment 


Conflict of interest statement

No competing interest or funding declared.


  1. 1.
    De Franco MJ, Lawton JN (2006) Radial nerve injuries associated with humeral fractures. J Hand Surg 31A:655–663Google Scholar
  2. 2.
    Pollock FH, Drake D, Bovill EG, Day L, Trafton PG (1981) Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg 63A:239–243Google Scholar
  3. 3.
    Lowe JB, Sen SK, Mackinon SE (2002) Current approach to radial nerve paralysis. Plast Reconstr Surg 15:1099–1112CrossRefGoogle Scholar
  4. 4.
    Shao YC, Harwood P, Grotz MRW, Limb D, Giannoudis PV (2005) Radial nerve palsy associated with fractures of the shaft of the humerus, a systematic review. J Bone Joint Surg 87B:1647–1652Google Scholar
  5. 5.
    Ring D, Chin K, Jupiter JB (2004) Radial nerve palsy associated with high-energy humeral shaft fractures. J Hand Surg 29A:144–147Google Scholar
  6. 6.
    Kato N, Birch R (2006) Peripheral nerve paralysis associated with closed fractures and dislocations. Injury 37:507–512CrossRefPubMedGoogle Scholar
  7. 7.
    Samardzic M, Grujicic D, Milinkovic ZB (1990) Radial nerve lesions associated with fractures of humeral shaft. Injury 21:220–222CrossRefPubMedGoogle Scholar
  8. 8.
    Kim DH, Kam AC, Chandika P, Tiel RL, Kline DG (2001) Surgical management and outcome in patients with radial nerve palsy. J Neurosurg 95:573–583CrossRefPubMedGoogle Scholar
  9. 9.
    Larsen LB, Barfred T (2000) Radial nerve palsy after simple fracture of the humerus. Scand J Plast Reconstr Hand Surg 34:363–366CrossRefGoogle Scholar
  10. 10.
    Bostman O, Bakalim G, Vainionpaa S, Wilppula E, Patiala H, Rokkanen P (1986) Radial palsy in shaft fractures of the humerus. Acta Orthop Scand 57:316–319PubMedCrossRefGoogle Scholar
  11. 11.
    Sonneveld GJ, Patka P, van Mourik JC, Brore G (1987) Treatment of the fractures of the shaft of the humerus accompanied by paralysis of the radial nerve. Injury 18:404–406CrossRefPubMedGoogle Scholar
  12. 12.
    Postacchini F, Morace GB (1988) Fractures of the humerus associated with paralysis of the radial nerve. Ital J Orthop Traumatol 14(4):455–464PubMedGoogle Scholar
  13. 13.
    Foster RJ, Swiontkowski MF, Bach AW, Sack JT (1993) Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg 18:121–124CrossRefGoogle Scholar
  14. 14.
    Shah JJ, Bhati NA (1983) Radial nerve paralysis associated with fracture of humerus: a review of 62 cases. Clin Orthop Relat Res 172:171–176PubMedGoogle Scholar
  15. 15.
    Skyhoj Olsen T (1990) Arm and leg paresis as outcome predictors in stroke rehabilitation. Stroke 21:247–251Google Scholar
  16. 16.
    Bodner G, Buchberger W, Schocke M, Bale R, Huber B, Harpf C, Gassner E, Jaschke W (2001) Radial nerve palsy associated with humeral shaft fractures: evaluation with US—initial experience. Radiology 219:811–816PubMedGoogle Scholar
  17. 17.
    Bodner G, Huber B, Schwabegger A, Lutz M, Waldenberger P (1999) Sonographic detection of radial nerve entrapment within a humerus fracture. J Ultrasound Med 18(10):703–706PubMedGoogle Scholar
  18. 18.
    Ekholm R, Ponzer S, Törnkvist H, Adami J, Tidermark J (2008) Primary radial nerve palsy in patients with acute humeral shaft fractures. J Orthop Trauma 22(6):408–414CrossRefPubMedGoogle Scholar
  19. 19.
    Diabezies RJ, Banta CJ, Murphy CP, D’Ambrosia RD (1992) Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries. J Orthop Trauma 6:10–13Google Scholar
  20. 20.
    Holstein A, Lewis GB (1963) Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg 45A:1382–1388Google Scholar
  21. 21.
    Wang JP, Shen WJ, Chen WM, Huang CK, Shen YS, Chen TH (2009) Iatrogenic radial nerve palsy after operative management of humeral shaft fractures. J Trauma 66(3):800–803CrossRefPubMedGoogle Scholar
  22. 22.
    Yang KH, Han DY, Kim HJ (1997) Intramedullary entrapment of the radial nerve associated with humeral shaft fracture (case report). J Orthop Trauma 11:224–226CrossRefPubMedGoogle Scholar
  23. 23.
    Jawa A, McCarty P, Doornberg J, Harris M, Ring D (2006) Extra-articular distal-third diaphyseal fractures of the humerus. A comparison of functional bracing and plate fixation. J Bone Joint Surg Am 88:2343–2347CrossRefPubMedGoogle Scholar
  24. 24.
    Cognet JM, Fabre T, Durandeau A (2002) [Persistent radial palsy after humeral diaphyseal fracture: cause, treatment, and results 30 operated cases. Rev Chir Orthop Reparatrice Appar Mot 88(7):655–662PubMedGoogle Scholar
  25. 25.
    Kaiser TE, Sim FH, Kelly PJ (1981) Radial nerve palsy associated with humeral fractures. Orthopaedics 4:1245–1251Google Scholar
  26. 26.
    Amillo S, Barrios RH, Martinez-Peric R, Losada JI (1993) Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J Orthop Trauma 7:211–215CrossRefPubMedGoogle Scholar
  27. 27.
    Szekeres M (2006) Tenodesis extension splinting for radial nerve palsy. Tech Hand Up Extrem Surg 10(3):162–165CrossRefPubMedGoogle Scholar
  28. 28.
    Gousheh J, Arasteh E (2006) Transfer of a single flexor carpi ulnaris tendon for treatment of radial nerve palsy. J Hand Surg 31(5):542–546Google Scholar
  29. 29.
    Green DB, Hotchkiss RN, Pedersen WC, Wolf SW (2009) Green’s operative hand surgery, 5th edn. Elsevier, PhiladelphiaGoogle Scholar

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

Personalised recommendations