Arch Hand Microsurg.  2024 Sep;29(3):203-209. 10.12790/ahm.24.0003.

Radial nerve palsy associated with fractures of the humerus shaft: a review of the literature and current treatment trends

• Jang HS
• Lee SH
• Chang WJ
• Kim YJ

• KMID: 2558746
• DOI: http://doi.org/10.12790/ahm.24.0003

Abstract

Due to the anatomical characteristics of the radial nerve, a humeral shaft fracture can induce radial nerve palsy. Although the treatment for radial nerve palsy remains debatable, the options can be broadly classified as early exploratory surgery and initial expectant treatment. In cases of secondary paralysis, the definitive treatment primarily depends on the causative factor, with appropriate consideration of other important factors, such as the fracture characteristics and the patient's age and occupational factors, and after adequate discussion with the patient. However, if radial nerve function does not recover, a tendon or nerve transfer may be considered.

Keyword

Radial neuropathy; Humerus fractures; Tendon transfer; Nerve transfer

Figure

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  Fig. 1. Sural nerve cable graft for a 4-cm nerve gap. A 69-year-old female patient sustained an injury when her right arm was caught in a plastic-wrapping agricultural machine. She reported symptoms of radial nerve palsy, such as wrist drop, immediately after the injury. (A) An initial plain radiograph showed transverse humeral shaft fracture and fractures of both forearm bones. (B) Early exploratory surgery revealed that the radial nerve was partially severed and under traction over a long segment. (C) After removing the damaged area, a three-strand sural nerve cable graft was performed. (D) One year postoperatively, bone union was achieved and radial motor function almost reached grade 4 to 5. Written informed consent was obtained from the patient for the publication of this report including all clinical images.

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  Fig. 2. Treatment algorithm for radial nerve palsy with humerus fracture. (A) Primary radial nerve palsy. (B) Secondary radial nerve palsy. *Radial nerve exploration: After nerve exploration, neurolysis, primary nerve repair, or an interpositional nerve graft can be performed if needed. If the nerve defect gap is over 7 cm, nerve transfer or a tendon graft is recommended.

Reference

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