Content area
Full Text
Radial nerve palsy frequently accompanies humeral shaft fractures. The need for operative exploration in different situations continues to be debated.
Radial nerve palsy associated with radial shaft fracture is a common occurrence. Approximately 1 in 10 patients with a humeral shaft fracture will also have associated radial nerve palsy. In an epidemiologic study of 1.4 million people, the overall incidence of radial nerve palsy in 401 humeral shaft fractures was 8.5%.1 In a systematic literature review, Shao et al2 identified 532 radial nerve palsies in 4517 radial shaft fractures; an 11.8% incidence of radial nerve palsy.
The management of radial nerve palsy associated with a humeral shaft fracture is a topic of debate. Although it is known that the majority of these injuries are neuropraxias that will recover spontaneously, the indication and need for operative exploration has been disputed, with authors offering conflicting opinions.
While some surgeons have advocated different treatment algorithms for radial nerve palsies that occur secondary to a closed fracture reduction, others believe that the timing of the nerve palsy is irrelevant to the management decision.
Primary nerve palsies occur at the time of injury and are discovered during the patients' initial evaluation. Approximately 10% to 20% of nerve palsies develop during the course of treatment, commonly noted following a closed reduction, and are termed secondary nerve palsies.3 Complete motor loss is present in 50% to 68% of cases of radial nerve palsy, while the others are only partial motor loss or sensory loss.3
Surgeons advocating early operative exploration of radial nerve palsy cite several advantages, including:
* The surgical dissection is technically easier and safer when done acutely.
* Fracture fixation decreases the risk of further nerve damage that could occur due to continued fracture site motion.
* If shortening of the bone is required to obtain a primary repair, then it is better done prior to fracture healing.
* Fracture reduction and fixation reduces the risk of the nerve becoming entrapped in callus formation.
* The degree of nerve injury is identified, clarifying the anticipated future treatment and outcome for the patient.
Surgeons advocating observation of radial nerve palsy cite the following opposing viewpoints:
* There is a high rate of expected recovery.
* Observation eliminates unnecessary surgery.
*...