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

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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.

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References

  1. De Franco MJ, Lawton JN (2006) Radial nerve injuries associated with humeral fractures. J Hand Surg 31A:655–663

    Google Scholar 

  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:239–243

    Google Scholar 

  3. Lowe JB, Sen SK, Mackinon SE (2002) Current approach to radial nerve paralysis. Plast Reconstr Surg 15:1099–1112

    Article  Google Scholar 

  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:1647–1652

    Google Scholar 

  5. Ring D, Chin K, Jupiter JB (2004) Radial nerve palsy associated with high-energy humeral shaft fractures. J Hand Surg 29A:144–147

    Google Scholar 

  6. Kato N, Birch R (2006) Peripheral nerve paralysis associated with closed fractures and dislocations. Injury 37:507–512

    Article  PubMed  Google Scholar 

  7. Samardzic M, Grujicic D, Milinkovic ZB (1990) Radial nerve lesions associated with fractures of humeral shaft. Injury 21:220–222

    Article  CAS  PubMed  Google Scholar 

  8. Kim DH, Kam AC, Chandika P, Tiel RL, Kline DG (2001) Surgical management and outcome in patients with radial nerve palsy. J Neurosurg 95:573–583

    Article  CAS  PubMed  Google Scholar 

  9. Larsen LB, Barfred T (2000) Radial nerve palsy after simple fracture of the humerus. Scand J Plast Reconstr Hand Surg 34:363–366

    Article  CAS  Google Scholar 

  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 57:316–319

    Article  CAS  PubMed  Google Scholar 

  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 18:404–406

    Article  CAS  PubMed  Google Scholar 

  12. Postacchini F, Morace GB (1988) Fractures of the humerus associated with paralysis of the radial nerve. Ital J Orthop Traumatol 14(4):455–464

    CAS  PubMed  Google Scholar 

  13. Foster RJ, Swiontkowski MF, Bach AW, Sack JT (1993) Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg 18:121–124

    Article  CAS  Google Scholar 

  14. Shah JJ, Bhati NA (1983) Radial nerve paralysis associated with fracture of humerus: a review of 62 cases. Clin Orthop Relat Res 172:171–176

    PubMed  Google Scholar 

  15. Skyhoj Olsen T (1990) Arm and leg paresis as outcome predictors in stroke rehabilitation. Stroke 21:247–251

    Google Scholar 

  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 219:811–816

    CAS  PubMed  Google Scholar 

  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):703–706

    CAS  PubMed  Google Scholar 

  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):408–414

    Article  PubMed  Google Scholar 

  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 6:10–13

    Google Scholar 

  20. Holstein A, Lewis GB (1963) Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg 45A:1382–1388

    Google Scholar 

  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):800–803

    Article  PubMed  Google Scholar 

  22. Yang KH, Han DY, Kim HJ (1997) Intramedullary entrapment of the radial nerve associated with humeral shaft fracture (case report). J Orthop Trauma 11:224–226

    Article  CAS  PubMed  Google Scholar 

  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 88:2343–2347

    Article  PubMed  Google Scholar 

  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):655–662

    CAS  PubMed  Google Scholar 

  25. Kaiser TE, Sim FH, Kelly PJ (1981) Radial nerve palsy associated with humeral fractures. Orthopaedics 4:1245–1251

    Google Scholar 

  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 7:211–215

    Article  CAS  PubMed  Google Scholar 

  27. Szekeres M (2006) Tenodesis extension splinting for radial nerve palsy. Tech Hand Up Extrem Surg 10(3):162–165

    Article  PubMed  Google Scholar 

  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):542–546

    CAS  Google Scholar 

  29. Green DB, Hotchkiss RN, Pedersen WC, Wolf SW (2009) Green’s operative hand surgery, 5th edn. Elsevier, Philadelphia

    Google Scholar 

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Conflict of interest statement

No competing interest or funding declared.

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Authors and Affiliations

  1. Clinical Centre for Serbia, Institute for Orthopaedic Surgery and Traumatology, Višegradska 26, Belgrade, Serbia

    Marko Bumbaširević, Aleksandar Lešić & Ivan Milošević

  2. Clinical Centre of Serbia, Institute for Anesthesiology, Višegradska 26, Belgrade, Serbia

    Vesna Bumbaširević

  3. Institute for Orthopaedic Surgery, Mihajla Avramovića 25, Banjica, Belgrade, Serbia

    Goran Čobeljić

  4. Department of Trauma and Orthopaedics, University College London Medical School, North Middlesex University Hospital, Sterling Way, N18 1QX, London, UK

    Henry Dushan E. Atkinson

  5. 9 Sutcliffe Close, NW11 6NT, London, UK

    Henry Dushan E. Atkinson

Authors
  1. Marko Bumbaširević
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  2. Aleksandar Lešić
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  3. Vesna Bumbaširević
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  4. Goran Čobeljić
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  5. Ivan Milošević
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  6. Henry Dushan E. Atkinson
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Correspondence to Henry Dushan E. Atkinson.

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Bumbaširević, M., Lešić, A., Bumbaširević, V. et al. The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases. Arch Orthop Trauma Surg 130, 519–522 (2010). https://doi.org/10.1007/s00402-009-0951-4

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  • DOI: https://doi.org/10.1007/s00402-009-0951-4

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