Abstract
BackgroundLittle evidence regarding the extent of recovery of radial nerve lesions with associated humerus trauma exists. The aim of this study is to examine the incidence and resolution of types of radial nerve palsy (RNP) in operative and nonoperative humeral shaft fracture populations.Materials and MethodsRadial nerve lesions were identified as complete (RNPc), which included motor and sensory loss, and incomplete (RNPi), which included sensory-only lesions. Charts were reviewed for treatment type, radial nerve status, RNP resolution time, and follow-up time. Descriptive statistics were used to document incidence of RNP and time to resolution. Independent-samples t-test was used to determine significant differences between RNP resolution time in operative and nonoperative cohorts.ResultsA total of 175 patients (77 operative, 98 nonoperative) with diaphyseal humeral shaft injury between 2007 and 2016 were identified and treated. Seventeen out of 77 (22.1%) patients treated operatively were diagnosed preoperatively with a radial nerve lesion. Two (2.6%) patients developed secondary RNPc postoperatively. Eight out of 98 (8.2%) patients presented with RNP postinjury for nonoperatively treated humeral shaft fracture. All patients who presented with either RNPc, RNPi, or iatrogenic RNP had complete resolution of their RNP. No statistically significant difference was found in recovery time when comparing the operative versus nonoperative RNPc, operative versus nonoperative RNPi, or RNPc versus RNPi patient groups.ConclusionsAll 27 (100%) patients presenting with or developing radial nerve palsy in our study recovered. No patient required further surgery for radial nerve palsy. Radial nerve exploration in conjunction with open reduction and internal fixation (ORIF) appears to facilitate speedier resolution of RNP when directly compared with observation in nonoperative cases, although not statistically significantly so. These findings provide surgeons valuable information they can share with patients who sustain radial nerve injury with associated humerus shaft fracture or nonunion.Level of evidenceLevel III treatment study.
Highlights
Humeral shaft fractures account for 1–3% of all skeletal fractures and demonstrate a bimodal age distribution, with average age of incidence greater than 50 years [1,2,3]
Eight out of 98 (8.2%) patients presented with radial nerve palsy (RNP) postinjury for nonoperatively treated humeral shaft fracture
Radial nerve exploration in conjunction with open reduction and internal fixation (ORIF) appears to facilitate speedier resolution of RNP when directly compared with observation in nonoperative cases, not statistically significantly so
Summary
Humeral shaft fractures account for 1–3% of all skeletal fractures and demonstrate a bimodal age distribution, with average age of incidence greater than 50 years [1,2,3]. Ekholm et al [1] conducted a review of 401 consecutive humeral shaft fractures, noting that that 61% were Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) type A, or simple fractures, and 68% were the result of a low-energy fall. Previous studies have demonstrated that radial nerve palsy occurs in between 2 and 17% of cases and is the most frequent nerve lesion following humeral shaft fracture [18]. Ekholm et al [1] revealed the overall incidence of radial nerve palsy in closed humeral shaft fractures to be 8.5%. The aim of this study is to examine the incidence and resolution of types of radial nerve palsy (RNP) in operative and nonoperative humeral shaft fracture populations
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