Shao radial nerve palsy review

Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review

Shao YC, Harwood P, Grotz MR, et al. The Journal of bone and joint surgery. British volume 2005 · PMID 16326879 · doi:10.1302/0301-620x.87b12.16132

Question

How common is radial nerve palsy with humeral shaft fractures and should it be explored early or observed?

Design

Systematic review of published series of humeral shaft fractures with radial nerve palsy.

Patients

Patients with humeral shaft fractures complicated by primary or secondary radial nerve palsy.

Intervention

Expectant management with late exploration if no recovery

Comparison

Early surgical exploration

Primary outcome

Rate of spontaneous and overall radial nerve recovery

Key result

Radial nerve palsy complicated about 12% of humeral shaft fractures, most often middle and middle-distal transverse or spiral fractures; most recovered spontaneously with conservative care, and final outcomes were similar whether nerves were explored early or managed expectantly.

Limitations

Based on retrospective, heterogeneous series with selection bias for exploration.

Impact on practice

Supports initial observation of closed humeral shaft fractures with radial nerve palsy, reserving exploration for open injuries or failure of recovery after several months.