A radial nerve injury associated with a humeral shaft
fracture is an important injury pattern among trauma
patients.1 It is the most common peripheral nerve injury
associated with fracture of long bones.2–4 As our understanding
of the pathoanatomy of the humerus and surrounding
neurovascular structures has evolved, surgeons
have adapted their strategies to improve outcome. There
are differences in opinion regarding the treatment of
choice. Early exploration of the radial nerve claims a variety
of advantages. It is technically easier and safer than
the delayed procedure. Direct examination of the nerve
clarifies the diagnosis and the extent of the lesion. Early
stabilization of the fracture reduces the chance of the
nerve being enveloped by scar tissue and callus. Reduction
of the open fracture helps lessen the risk of further
neural damage from mobile bone ends. Shortening of the
humerus to facilitate nerve repair is better done before
healing of the fracture is complete.5–8 However, opponents
of early exploration have observed high rate of
spontaneous recovery and have advised a policy of expectancy,
9–16 believing that this approach mitigates an
unnecessary complications attendant on exploration.
Thickening of the neurilemmal sheath while waiting helps
to define the extent of nerve damage and facilitates
repair. It is easier to treat the nerve when the fracture is
healed. Most of these articles describe small numbers of
patients and all are uncontrolled retrospective case series.
Although treatment for this injury pattern is a controversial
subject among upper-extremity surgeons, certain principles
of management need to be applied in all cases. We
limited our analysis to posthumeral fracture radial nerve
palsies, which were operated due to the presence of neurological
deficits after the fracture. We recorded the type
of fracture, treatment used to achieve bone healing, surgical
approach, and type of radial nerve surgery.