Current Treatment of Radial Nerve Palsy Following Fracture of the Humeral Shaft

Abstract

The association between radial nerve injury and humeral shaft fracture was described by Berkeley surgeons Holstein and Lewis, 1 Holstein A. Lewis G.B. Fractures of the humerus with radial-nerve paralysis. J Bone Joint Surg. 1963; 45A: 1382-1388 Google Scholar who observed radial nerve palsy in the setting of spiral fractures of the distal third of the humeral shaft wherein “the distal bone fragment is always displaced proximally with its proximal end deviated radialward” and that “the radial nerve is caught in the fracture site.” Subsequent reports have described cases of radial nerve palsy following fractures of the middle third of the shaft of the humerus as well. 2 Ekholm R. Adami J. Tidermark J. Hansson K. Törnkvist H. Ponzer S. Fractures of the shaft of the humerus, an epidemiological study of 401 fractures. J Bone Joint Surg. 2006; 88B: 1469-1473 Google Scholar , 3 Shao Y.C. Harwood P. Grotz M.R.W. Limb D. Giannoudis P.V. Radial nerve palsy associated with fractures of the shaft of the humerus. J Bone Joint Surg. 2005; 87B: 1647-1652 Google Scholar , 4 Kettelkamp D.B. Alexander H. Clinical review of radial nerve injury. J Trauma. 1967; 7: 424-432 Crossref PubMed Scopus (61) Google Scholar , 5 Packer J.W. Foster R.R. Garcia A. Grantham S.A. The humeral fracture with radial nerve palsy: is exploration warranted?. Clin Orthop. 1972; 88: 34-38 Crossref PubMed Scopus (66) Google Scholar , 6 Pollock F.H. Drake D. Bovill E.G. Day L. Trafton P.G. Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg. 1981; 63A: 239-243 Google Scholar , 7 Samardžić M. Grujičić D. Milinković Z.B. Radial nerve lesions associated with fractures of the humeral shaft. Injury. 1990; 21: 220-222 Abstract Full Text PDF PubMed Scopus (69) Google Scholar , 8 DeFranco M.J. Lawton J.N. Radial nerve injuries associated with humeral fractures. J Hand Surg. 2006; 31A: 655-663 Abstract Full Text Full Text PDF Scopus (95) Google Scholar A recently published anatomical study by Carlan et al. emphasizes that the radial nerve is at risk of injury in these 2 regions: (1) along the posterior mid-aspect of the humerus where the nerve lies in direct contact with the periosteum and (2) along the distal lateral humerus where the nerve pierces the lateral intermuscular septum. 9 Carlan D. Pratt J. Patterson J.M.M. Weiland A.J. Boyer M.I. Gelberman R.H. The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg. 2007; 32A: 1177-1182 Google Scholar