Abstract

The overall prevalence of radial nerve injury after humeral shaft fractures is up to 18% representing the most common peripheral nerve injury associated with long bone fractures. Spiral or oblique fractures of the junction between the middle and distal third of the humeral shaft are at greater risk for radial nerve injury. Iatrogenic damage to the radial nerve may also occur during manipulations of closed reduction. A prospective study between 2017-2019 following 5 patients (all male, with ages between 30 and 56 years old), who were treated at our clinic for complete radial nerve palsy after a high-energy fracture of the humerus. All the patients were followed-up for a mean of 6 months (range 4 - 15 months) post op. The first 3 cases showed the initial signs of recovery 4 weeks after the operation. In the last 2 cases a palliative radial intervention was required. The consequences of the radial nerve palsy associated with humeral fractures is strongly related to trauma mechanism. In high energy fractures, severe contusion or transection of the nerve must be expected. In this case, nerve recovery is unlikely and the patients should be informed of the poor prognosis and the need of tendon transfers.

Highlights

  • The overall prevalence of radial nerve injury after humeral shaft fractures is up to 18% representing the most common peripheral nerve injury associated with long bone fractures [1,2,3,4,5]

  • The same anterolateral approach used for plating, was used during our surgical exploration where we found contusion of the radial nerve and perineurial adhesions of a small segment at the level of the humeral fracture (Fig 1)

  • In the last 2 cases where palliative radial intervention practicing tendon transfer was used, the imobilization was removed after approximately 4 weeks and a volar custom splint made by a hand therapist was applied with extension slings for the MP joint of the fingers

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Summary

Introduction

The overall prevalence of radial nerve injury after humeral shaft fractures is up to 18% representing the most common peripheral nerve injury associated with long bone fractures [1,2,3,4,5] This is caused by the relatively fixed position of the radial nerve and the direct contact with the periosteum of the humerus as the nerve courses through the middle and distal thirds of the upper arm and by the nerve’s diminished mobility where it pierces the lateral intermuscular septum. A prospective study between 2017-2019 following 5 patients (all male, with ages between 30 and 56 years old), who were treated at our institution for complete radial nerve palsy after a high-energy fracture of the humerus. Baseline electrophysiological studies (i.e. nerve conduction velocity studies and electromyography) conducted before admittance showed a complete motor paralysis of the nerve and all had an absent Tinel’s sign at each clinical examination

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