Secondary radial nerve palsy after internal fixation of humeral shaft fractures

Objective and background

There was no agreement with regard to the treatment for secondary radial nerve palsy. This study aimed to investigate at what point should exploration of the nerve be considered.

Methods

One hundred and twenty-five patients with fracture of the diaphyseal humerus treated with internal fixation at our hospital from February 2000 to February 2010 were reviewed retrospectively. There were six cases of secondary radial nerve palsy occurred soon after humeral internal fixation. No recognized intraoperative injuries to the radial nerve were recorded. Initial conservative observation was carried out in all six cases.

Results

Follow-up period averaged 28 months (range 24–37 months). In four cases, the beginning of electromyography recovery averaged 3.5 months (range 1–5 months), the meantime of onset of clinical recovery was 4.8 months (range 1–6 months), and the average time to full recovery of wrist and finger extension was 8.5 months (range 3–12 months). In other two cases, nerve exploration was made when there was no nerve recovery 3 months after internal fixation of humeral fracture at the request of patients. There were no macroscopic lesions of the radial nerve. At 2-year follow-up, extension of wrist and finger recovered to nearly normal in these two cases.

Conclusions

For treatment for secondary radial nerve palsy, it seems reasonable to consider watchful waiting for about 5 months before nerve exploration if the decision as to the period of waiting was based on the clinical recovery onset time.