Primary radial nerve palsy in patients with acute humeral shaft fractures

Radford Ekholm, Sari Ponzer, Hans Törnkvist, Johanna Adami, Jan Tidermark
Journal of Orthopaedic Trauma 2008, 22 (6): 408-14

OBJECTIVE: The primary aim was to report on the recovery of radial nerve function in patients with acute closed humeral shaft fractures and associated primary radial nerve palsy. The secondary aim was to report on the long-term functional outcome and health-related quality of life (HRQoL) in patients with this specific injury.

SETTING: Six major hospitals in Stockholm County.

DESIGN: Descriptive study. Retrospective assessment of radial nerve recovery and fracture healing. Prospective assessment of functional outcome and HRQoL.

PATIENTS: Thirty-three patients with acute radial nerve palsy and a closed humeral shaft fracture in a population of 358 patients with 361 humeral shaft fractures.

INTERVENTION: Nonoperative or operative treatment as per decision of the attending orthopedic surgeon.

MAIN OUTCOME MEASUREMENTS: Recovery of the radial nerve, fracture healing, functional outcome according to the Short Musculoskeletal Function Assessment (SMFA) and the Disabilities of the Arm, Shoulder and Hand (DASH). HRQoL according to Short Form 36 (SF-36).

RESULTS: Among the 18 patients treated nonoperatively, 16 (89%) displayed a complete recovery from their radial nerve palsy while 2 (11%) presented minor sequelae. In 11 (73%) of the 15 patients treated primarily operatively, the nerve function recovered completely while 2 patients (13%) had minor sequelae and 2 (13%) had major sequelae, i.e. 1 partial nerve palsy and 1 total radial nerve palsy. Sixteen patients (48%) were available for assessment of the long-term functional outcome and HRQoL at a mean of 7 years (range, 6 to 8 years). The range of motion and the muscular strength of the injured arm, the functional outcome according to the SMFA, and HRQoL according to the SF-36 showed results comparable to those previously reported for patients with healed humeral shaft fractures without associated radial nerve palsy.

CONCLUSION: This study confirms the high spontaneous recovery rate of primary radial nerve palsies in patients with closed humeral shaft fractures. Primary radial nerve palsy should not be regarded as an isolated indication for primary surgical intervention.

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