Comparison of Initial Nonoperative and Operative Management of Radial Nerve Palsy Associated With Acute Humeral Shaft Fractures

Liu, Geng yan; Zhang, Chao yue; Wu, Hong wei

doi:10.3928/01477447-20120725-10

Cited by 38 publications

(30 citation statements)

References 18 publications

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“…No significant difference in the recovery rate could be demonstrated when comparing non-operative treatment versus operative treatment with nerve exploration. We therefore support earlier recommendations [4,54] to manage patients with a closed humeral shaft fracture and an associated RNP non-operatively if the fracture allows it. This avoids the risk of potential operative complications and does not affect the recovery of the radial nerve adversely, while high union rates have been demonstrated with non-operative management in closed humeral shaft fractures [55].…”

Section: Discussionsupporting

confidence: 85%

Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients

Hendrickx

Hilgersom

Alkaduhimi

et al. 2020

Arch Orthop Trauma Surg

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Background and purpose Humeral shaft fractures are often associated with radial nerve palsy (RNP) (8-16%). The primary aim of this systematic review was to assess the incidence of primary and secondary RNP in closed humeral shaft fractures. The secondary aim was to compare the recovery rate of primary RNP and the incidence of secondary RNP between operative and non-operative treatment. Methods A systematic literature search was performed in 'Trip Database', 'Embase' and 'PubMed' to identify original studies reporting on RNP in closed humeral shaft fractures. The Coleman Methodology Score was used to grade the quality of the studies. The incidence and recovery of RNP, fracture characteristics and treatment characteristics were extracted. Chi-square and Fisher exact tests were used to compare operative versus non-operative treatment. Results Forty studies reporting on 1758 patients with closed humeral shaft fractures were included. The incidence of primary RNP was 10%. There was no difference in the recovery rate of primary RNP when comparing operative treatment with radial nerve exploration (98%) versus non-operative treatment (91%) (p = 0.29). The incidence of secondary RNP after operative and non-operative treatment was 4% and 0.4%, respectively (p < 0.01). Interpretation One-in-ten patients with a closed humeral shaft fracture has an associated primary RNP, of which > 90% recovers without the need of (re-)intervention. No beneficial effect of early exploration on the recovery of primary RNP could be demonstrated when comparing patients managed non-operatively with those explored early. Patients managed operatively for closed humeral shaft fractures have a higher risk of developing secondary RNP. Level of evidence Level IV; Systematic Review.

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Section: Discussionsupporting

confidence: 85%

Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients

Hendrickx

Hilgersom

Alkaduhimi

et al. 2020

Arch Orthop Trauma Surg

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“…One of the most common reasons for peripheral nerve palsy is an injury of the radial nerve associated with a fracture of the humeral shaft [ 1 – 4 ]. Regarding the literature, the overall incidence of radial nerve palsy in patients with humeral shaft fracture is between 7 and 17% [ 3 ]. One can differ between primary or traumatic nerve injury and secondary or iatrogenic nerve injury following fracture fixation or manipulation [ 3 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome

Schwab

Stillhard

Schibli

et al. 2017

Eur J Trauma Emerg Surg

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IntroductionThe incidence of radial nerve injury after humeral shaft fractures is on average 11.8% (Shao et al., J Bone Jt Surg Br 87(12):1647–1652, 2005) representing the most common peripheral nerve injury associated with long bone fractures (Korompilias et al., Injury, 2013). The purpose of this study was to analyze our current policy and long-term outcome, regarding surgically treated humeral shaft fractures in combination with radial nerve palsy.Materials and methodsWe retrospectively analyzed the data of patients with surgically treated humeral shaft fractures from 01/01/2003 to 28/02/2013. The analysis included fracture type, soft tissue injury regarding closed and open fractures, type of fixation, management, and outcome of radial nerve palsy.ResultsA total of 151 humeral shaft fractures were fixed in our hospital. In 20 (13%) cases, primary radial palsy was observed. Primary nerve exploration was performed in nine cases. Out of the 13 patients with follow-up, 10 showed a complete, 2 a partial, and 1 a minimal nerve recovery. Two of them underwent a revision procedure. Secondary radial nerve palsy occurred in 9 (6%) patients postoperatively. In five patients, the radial nerve was not exposed during the initial surgery and, therefore, underwent revision with nerve exploration. In all 5, a potential cause for the palsy was found and corrected as far as possible with full recovery in 3 and minimal recovery in one patient. In four patients with exposure of the nerve during the initial surgery, no revision was performed. All of these 4 showed a full recovery.ConclusionOur study showed an overall rate of 19% radial nerve palsy in surgically treated humeral shaft fractures. Most of the primary palsies (13%) recovered spontaneously, and therefore, nerve exploration was only exceptionally needed. The incidence of secondary palsy after surgery (6%) was high and mainly seen after plate fixation. In these cases, we recommend early nerve exploration, to detect and treat potential curable neural lesions.

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“…Trotz der Häufigkeit der Verletzung hat sich bisher jedoch kein Konsens etabliert, der von den Befürwortern der primären Intervention und denen des abwartenden Procedere gleichermaßen akzeptiert wird. Auch aktuelle Metaanalysen konnten keinen für beide Seiten überzeu-genden Vorteil der jeweiligen Strategien belegen [15].…”

Section: Hintergrund Und Fragestellungunclassified

Paresen des N. radialis bei Humerusschaftfrakturen

et al. 2015

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Comparison of Initial Nonoperative and Operative Management of Radial Nerve Palsy Associated With Acute Humeral Shaft Fractures

Cited by 38 publications

References 18 publications

Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients

Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients

Radial nerve palsy in humeral shaft fractures with internal fixation: analysis of management and outcome

Paresen des N. radialis bei Humerusschaftfrakturen

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