The radial nerve is most at risk for injury with fractures of the humeral shaft due to its spiral course across the back of the midshaft humerus. Radial nerve palsy occurs in around 12% of humeral shaft fractures. Recovery rates are around 88% overall, with complete recovery in up to 100% of low-energy injuries. For closed fractures, the nerve is usually just bruised or stretched and will recover spontaneously without need for exploration. Complete transection requiring repair is rare and usually only occurs with open fractures. Nonoperative treatment with splinting is sufficient in most cases of radial nerve palsy from closed humeral fractures.

1. FRACTURES OF THE HUMERAL
SHAFT WITH RADIAL NERVE
PALSY
Dr.Ponnilavan

2. • Radial nerve - most frequently
injured with humeral shaft #
because of its spiral course across
back of midshaft humerus
- Its relatively fixed position in the
distal arm as it penetrates the
lateral intermuscular septum
anteriorly

3. In radial nerve injury –recovery rates of - 100% in low-energy
injuries &
- up to 71% in high-energy open injuries;
Bumbasirevic et al. reported recovery in 94% of 16 open
fractures.
Although it is possible for the nerve to be severed by the sharp
edge of a bone fragment, this rarely occurs.

4. In nonoperative humeral shaft # , support
wrist & fingers with a dynamic splint, &
reserve nerve exploration for instances
when function has not returned in 3 to 4
mts & # has healed.
Because the nerve usually is only bruised or
stretched, function can be expected to
return spontaneously.

5. Routine nerve exploration would
subject many patients to an
unnecessary operation & might
increase the frequency of
complications.
Early exploration & repair of a
severed nerve have not been
proved to produce any better
results than repair at a later date

6. If radial nerve palsy occurs with an open humeral shaft #, the nerve
should be explored at time of irrigation & wound debridement.
If it is found intact, only watchful waiting is required while # heals.
Early exploration is required if evidence suggests that the radial
nerve is impaled on a bone fragment or is caught b/w fragments.

7. Advances in USG have been useful
in diagnosing entrapped &
lacerated radial nerves.
If this diagnostic tool proved to be
reproducible in large no. of pts,
indications for nerve exploration
would be more specifically defined.

8. In radial nerve palsy pts for whom operative Rx of a humeral shaft # is indicated,
the nerve should be explored at the time of fracture fixation.
Shao et al. reviewed 21 scientific articles that included 4517 humeral shaft #s &
found an overall prevalence of radial nerve palsy of almost 12% (n = 532).

9. Based on their
review, Shao et al.
developed an
algorithm for the
treatment of radial
nerve palsy
associated with
humeral shaft
fractures

11. Summary
• Radial nerve palsy was most frequent with fractures of middle &
middle-distal humeral shaft & was more common with transverse &
spiral fractures than with oblique or comminuted fractures.
• Overall, recovery occurred in 88%
• Complete transection of the radial nerve usually occurs with open
humerus # & requires nerve repair or grafting
• most nerve palsies that occur with a closed fracture recover without
treatment.

12. Source –
CAMPBELL 12th
edition
Chapter - 57