Radial Nerve Palsy With Fracture Shaft Of The Humerus Treated With Early Limited Nerve Exploration And Internal Fixation

Radial Nerve Palsy With Fracture Shaft Of The Humerus

Authors

  • Deepak Jain
  • Harpal Selhi
  • Pankaj Mahindra
  • Mohammad Yamin

DOI:

https://doi.org/10.70284/njirm.v3i5.2091

Keywords:

Exploration, Fracture shaft humerus, Radial nerve palsy

Abstract

Background and Objective: Radial nerve injuries associated with fractures of the humerus are the most common peripheral nerve injuries in long bone fractures. Management of these injuries remains controversial. Strong convictions for and against either line of treatment - conservative or operative can be drawn from the literature. This study evaluates the role of early limited exploration in these injuries. Methods: Sixteen patients with radial nerve palsy with fracture shaft of humerus treated with open reduction and internal fixation with plates were studied. Follow up of the patients was done with regard to intraoperative findings and pattern of recovery. Results: Radial nerve continuity with spontaneous clinical recovery was seen in all of our cases. The average time for onset of recovery in our study was two weeks for neurapraxia and 22 weeks for axonotmesis. The average time for complete recovery was five weeks for neurapraxia and 30 weeks for axonotmesis. 88% of our cases showed excellent and 12% showed good results. Conclusions and interpretation: Limited early nerve exploration of radial nerve is a reliable option while performing internal fixation for both primary as well as secondary radial nerve palsy with fracture of shaft of humerus.

References

1. Crenshaw AH. Fracture of humeral shaft with radial nerve palsy. In: Crenshaw AH, ed. Campbell’s operative orthopaedics. Vol. 2, Eighth ed. St. Louis: Mosby Year Book, 1992:1016
2. Guse TR and Ostrum RF. The surgical anatomy of the radial nerve around the humerus. Clin Orthop 1995; 320: 149-153.
3. Shao YC, Harwood P, Grotz MR et al. Radial nerve palsy associated with fractures of the shaft of the humerus: A systematic review. J Bone Joint Surg (Br) 2005; 87B: 1647-52.
4. Sakellarides H. A follow up of study of 172 peripheral nerve injuries in the upper extremity in civilians. J Bone Joint Surg 1962; 44A:140-148.
5. Whitson RO. Relation of the radial nerve to the shaft of the humerus. J Bone Joint Surg 1954; 36A: 85-88.
6. Shah JJ and Bhatti NA. Radial nerve paralysis associated with fractures of the humerus. Clin Orthop 1983; 172: 171-176.
7. Lewis D and Miller EM. Peripheral nerve injuries associated with fractures. Ann Surg 1922; 76: 528-538.
8. Pollock FH, Drake D, Bovill EG et al. Treatment of radial neuropathy associated with fractures of humerus. J Bone Joint Surg 1982; 63A: 239-243.
9. Holstein A and Lewis GB. Fractures of the humerus with radial nerve paralysis. J Bone Joint Surg 1963; 45A: 1382-1388.
10. Packer JW, Foster RR, Garcia A et al. The humeral fracture with radial nerve palsy: Is exploration warranted? Clin Orthop 1972; 88: 34-38.11. Foster RJ, Swiontkowski MF, Bach AW et al. Radial nerve palsy caused by open humeral shaft fractures. J Hand Surg 1993; 18A: 121-124.
12. Larsen lB and Barfred T. Radial nerve palsy after simple fracture of the humerus. Scand J Plast Reconst Hand Surg 2000; 34: 363-366.
13. Samardzic M, Grujicic D and Milinkovic ZB. Radial nerve lesions associated with fractures of the humeral shaft. Injury 1999; 4: 220-222.
14. Kettelkamp DB and Alexander H. Clinical review of radial nerve injury. J Trauma 1967; 7: 424-432.
15. Shaw JL and Sakellarides H. Radial nerve paralysis associated with fractures of the humerus. J Bone Joint Surg 1967; 49A: 899-902.
16. Gosler MW, Testroote M, Morrenhof JW et al. Surgical versus non-surgical interventions for treating humeral shaft fractures in adults. Cochrane Database of Systematic Reviews 2012, Issue 1. Art. No.: CD008832. DOI: 10.1002/14651858.CD008832.pub2.
17. Zafar MS and Porter K. Humeral shaft fractures: a review of literature. Trauma 2007; 9(4): 273–82.
18. Toivanen JA, Nieminen J, Laine HJ et al. Functional treatment of closed humeral shaft fractures. Int Orthop 2005; 29(1): 10–3.
19. Juan M. Concha JM, Sandoval A and Streubel PN. Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible. Int Orthop 2010; 34: 1297-1305.

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Published

2012-12-31

How to Cite

Jain, D., Selhi, H., Mahindra, P., & Yamin, M. (2012). Radial Nerve Palsy With Fracture Shaft Of The Humerus Treated With Early Limited Nerve Exploration And Internal Fixation: Radial Nerve Palsy With Fracture Shaft Of The Humerus. National Journal of Integrated Research in Medicine, 3(5), 8–13. https://doi.org/10.70284/njirm.v3i5.2091

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Original Articles