Late-Onset Radial Nerve Palsy Associated with Conservatively Managed Humeral Fracture. A Case Report and Suggested Classification System

Abstract

Radial nerve palsy can occur with humerus fracture, either at the time of injury (primary) or during reduction (secondary). Late-onset radial nerve palsy (not immediately related to injury or reduction) has been very seldom reported in the English literature. We describe a case of late-onset radial nerve palsy, which developed 9 weeks after an attempted closed management of a midshaft humerus fracture. Exploration of the nerve was performed. The radial nerve was found to be stretched over the ends of the fracture. Open reduction and external fixation of the fracture with mobilization of the nerve from the fracture site lead to complete return of radial nerve function occurring by 3 months. We recommend exploration of cases of late-onset radial nerve palsy in contrast to primary or secondary radial nerve palsy, which can be treated conservatively. Our experience suggests that the cause of the palsy is a continuous ongoing pathology and not a single time event as in primary or secondary cases. Radial nerve palsies associated with humeral fracture should be classified as either primary (at the time of injury), secondary (at the time of reduction), or late onset (not related to either injury or reduction).

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3

References

  1. 1.

    Pollock FH, Drake D, Bovill EG, Day L, Trafton PG (1981) Treatment of radial neuropathy associated with fractures of the humerus. J. Bone Jt. Surg. Am. 63(2):239–243

    CAS  Google Scholar 

  2. 2.

    Shao YC, Harwood P, Grotz MR, Limb D, Giannoudis PV (2005) Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review. J. Bone Jt. Surg. Br. 87(12):1647–1652

    Article  CAS  Google Scholar 

  3. 3.

    Ekholm R, Adami J, Tidermark J, Hansson K, Törnkvist H, Ponzer S (2006) Fractures of the shaft of the humerus. An epidemiological study of 401 fractures. J. Bone Jt. Surg. Br. 88(11):1469–1473

    Article  CAS  Google Scholar 

  4. 4.

    Shaw J, Sakellarides H (1967) Radial-nerve paralysis associated with fractures of the humerus: a review of forty-five cases. J. Bone Jt. Surg. 49A:899–902

    Google Scholar 

  5. 5.

    Kettelkamp D, Alexander H (1967) Clinical review of radial nerve injury. J. Trauma 7:424–432

    Article  CAS  PubMed  Google Scholar 

  6. 6.

    Bostman O, Bakalim G, Vaniionpaa S, Wilppula E, Patiala H, Rokkanen P (1986) Radial palsy in shaft fracture of the humerus. Acta. Orthop. Scand. 57:316–319

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    DeFranco MJ, Lawton JN (2006) Radial nerve injuries associated with humeral fractures. J. Hand Surg. [Am]. 31(4):655–663

    Article  Google Scholar 

  8. 8.

    Chesser TJ, Leslie IJ (2000) Radial nerve entrapment by the lateral intermuscular septum after trauma. J. Orthop. Trauma. 14(1):65–66

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Edwards P, Kurth L (1992) Postoperative radial nerve paralysis caused by fracture callus. J. Orthop. Trauma. 6(2):234–236

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Ueda N, Susuki K, Tanigawa A, Kuroiwa Y, Obayashi O (2001) Delayed radial nerve palsy following a humeral shaft fracture. Rinsho Shinkeigaku. 41(6):322–324

    CAS  PubMed  Google Scholar 

  11. 11.

    Shah JJ, Bhatti NA. Radial nerve paralysis associated with fractures of the humerus. A review of 62 cases. Clin. Orthop. Relat. Res. 1983; (172): 171–176

  12. 12.

    Duthie HL (1957) Radial nerve in osseous tunnel at humeral fracture site diagnosed radiographically. J. Bone Jt. Surg. Br. 39-B(4):746–747

    CAS  Google Scholar 

  13. 13.

    Amillo S, Barrios RH, Martínez-Peric R, Losada JI (1993) Surgical treatment of the radial nerve lesions associated with fractures of the humerus. J. Orthop. Trauma. 7(3):211–215

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Amr Atef Abdelgawad MD.

Additional information

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of this case, that all investigations were conducted in conformity with ethical principles of research.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Abdelgawad, A.A., Wassef, A. & Ebraheim, N.A. Late-Onset Radial Nerve Palsy Associated with Conservatively Managed Humeral Fracture. A Case Report and Suggested Classification System. HSS Jrnl 6, 49–51 (2010). https://doi.org/10.1007/s11420-009-9137-4

Download citation

Keywords

  • radial nerve palsy
  • classification
  • humerus fracture
  • external fixator
  • late onset