P143. MANAGEMENT OF RADIAL NERVE PALSY: SYSTEMATIC REVIEW AND POOLED ANALYSIS

Abstract

PURPOSE: Isolated radial nerve palsy is a debilitating injury treated with tendon transfers, nerve grafts, and nerve transfers. There is no consensus on the optimal technique for reconstruction. Therefore, we performed a systemic review and pooled analysis to determine which surgical intervention provides the best outcomes. METHODS: A systemic review was conducted according to PRISMA guidelines. Twenty-four papers met inclusion criteria. Grading scales were converted into a tripartite scoring system to compare outcomes between techniques. Pooled Chi-squared analyses were performed with a p-value < 0.05. RESULTS: Three hundred seventy patients were analyzed. Tendon transfers resulted in the greatest percentage of good outcomes (82%) and the lowest percentage of poor outcomes (9%). Outcomes in nerve transfer were superior in proximal joints. Rates of good and poor outcomes were equivalent at all joint levels for tendon transfers and nerve grafts. At the wrist, tendon transfers were superior to nerve grafts and nerve transfers. Nerve grafts and nerve transfers provided equivalent outcomes at all three levels. CONCLUSION: Our study analyzed reported outcomes of tendon transfers, nerve grafts, and nerve transfers for reconstruction of isolated radial nerve palsy. Pooled analysis demonstrated that tendon transfers had higher rates of superior outcomes with similar rates of inferior outcomes as compared to nerve transfers and nerve grafts. Our findings suggest that tendon transfers should always be considered for reconstruction of patients with isolated radial nerve palsy because nerve-based reconstruction is less reproducible.