Early nerve exploration vs. Conservative observation in clinical management of radial nerve palsy associated with humeral shaft fracture

Abstract

Objective To compare early nerve exploration and conservative observation in the clinical management of the radial nerve palsy (RNP) associated with humeral shaft fracture. Methods From March 1995 to October 2005, 708 cases of humeral shaft fracture were treated in our department. Of them, 86 were complicated with RNP and fully followed up. Their average age was 34. 0 years old (range, 15to 66 years). Fifty-two patients (group A) were treated with early nerve exploration and 34 (group B) with conservative observation. Functional recovery of the radial nerve was compared between the 2 groups.Results In group A, 4 cases (7. 7% ) needed a secondary surgery, while 50(96. 2% ) obtained complete functional recovery, one ( 1.9% ) partial recovery and one ( 1.9% ) no recovery. In group B, 30 cases (88. 2% ) recovered spontaneously, 4 ( 11.8% ) required late surgical exploration, 33 (97. 1% ) obtained complete recovery and one (2. 9% ) partial recovery. There was no significant difference between group A and group B in functional recovery of the nerve (x2 =0. 050, P = 1. 000). The initial recovery time and full recovery time of nerve function were (5. 3 ± 4. 1 ) and ( 14. 7 ± 8.2) weeks in group A and (4. 5 ± 3.9) and ( 11.6 ± 8.7) weeks in group B, without any significant difference between the 2 groups ( P > 0. 05) .Conclusions Early nerve exploration and conservative observation may have similar neural recovery in management of RNP associated with humeral shaft fracture. We recommend conservative observation as a primary choice for RNP associated with closed humeral shaft fractures if no contraindications exist. Key words: Radial nerve; Wounds and injuries; Humeral fracture; Therapy