Download PDF
J Reconstr Microsurg 2008; 24(8): 569-573
DOI: 10.1055/s-0028-1090623
© Thieme Medical Publishers

Management of Radial Nerve Injury Associated with Humeral Shaft Fractures: An Evidence-Based Approach

Suzanne G. Elton1 , Marco Rizzo1
  • 1Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
Further Information

Publication History

Publication Date:
16 October 2008 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Injury to the radial nerve is not uncommonly associated with fractures of the humerus. Despite a considerable amount of information and literature regarding management of these associated injuries, a universally accepted algorithm for treatment remains elusive. This article assimilates the data and provides evidence-based recommendations regarding treatment.

KEYWORDS

Radial nerve - humerus fracture - trauma

REFERENCES

  • 1 Ekholm R, Adami J, Tidermark J, Hansson K, Tornkvist H, Ponzer S. Fractures of the shaft of the humerus: an epidemiological study of 401 fractures.  J Bone Joint Surg Br. 2006;  88(11) 1469-1473
    PubMedSearch in Google Scholar
  • 2 Mast J W, Spiegel P G, Harvey Jr J P, Harrison C. Fractures of the humeral shaft: a retrospective study of 240 adult fractures.  Clin Orthop Relat Res. 1975;  (112) 254-262
    CrossrefPubMedSearch in Google Scholar
  • 3 Tytherleigh-Strong G, Walls N, McQueen M M. The epidemiology of humeral shaft fractures.  J Bone Joint Surg Br. 1998;  80(2) 249-253
    CrossrefPubMedSearch in Google Scholar
  • 4 Noble J, Munro C A, Prasad V S, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries.  J Trauma. 1998;  45(1) 116-122
    CrossrefPubMedSearch in Google Scholar
  • 5 Holstein A, Lewis G M. Fractures of the humerus with radial-nerve paralysis.  J Bone Joint Surg Am. 1963;  45 1382-1388
    PubMedSearch in Google Scholar
  • 6 Amillo S, Barrios R H, Martinez-Peric R, Losada J I. Surgical treatment of the radial nerve lesions associated with fractures of the humerus.  J Orthop Trauma. 1993;  7(3) 211-215
    CrossrefPubMedSearch in Google Scholar
  • 7 Samardzic M, Grujicic D, Milinkovic Z B. Radial nerve lesions associated with fractures of the humeral shaft.  Injury. 1990;  21(4) 220-222
    CrossrefPubMedSearch in Google Scholar
  • 8 Bostman O, Bakalim G, Vainionpaa S, Wilppula E, Patiala H, Rokkanen P. Radial palsy in shaft fracture of the humerus.  Acta Orthop Scand. 1986;  57(4) 316-319
    PubMedSearch in Google Scholar
  • 9 Pollock F H, Drake D, Bovill E G, Day L, Trafton P G. Treatment of radial neuropathy associated with fractures of the humerus.  J Bone Joint Surg Am. 1981;  63(2) 239-243
    PubMedSearch in Google Scholar
  • 10 Shao Y C, Harwood P, Grotz M R, Limb D, Giannoudis P V. Radial nerve palsy associated with fractures of the shaft of the humerus: a systematic review.  J Bone Joint Surg Br. 2005;  87(12) 1647-1652
    CrossrefPubMedSearch in Google Scholar
  • 11 Omer Jr G E. Results of untreated peripheral nerve injuries.  Clin Orthop Relat Res. 1982;  (163) 15-19
    PubMedSearch in Google Scholar
  • 12 Lowe III J B, Sen S K, Mackinnon S E. Current approach to radial nerve paralysis.  Plast Reconstr Surg. 2002;  110(4) 1099-1113
    CrossrefPubMedSearch in Google Scholar
  • 13 Robinson L R. Traumatic injury to peripheral nerves.  Muscle Nerve. 2000;  23(6) 863-873
    CrossrefPubMedSearch in Google Scholar
  • 14 Shah J J, Bhatti N A. Radial nerve paralysis associated with fractures of the humerus: a review of 62 cases.  Clin Orthop Relat Res. 1983;  (172) 171-176
    PubMedSearch in Google Scholar
  • 15 Postacchini F, Morace G B. Fractures of the humerus associated with paralysis of the radial nerve.  Ital J Orthop Traumatol. 1988;  14(4) 455-464
    PubMedSearch in Google Scholar
  • 16 Bodner G, Huber B, Schwabegger A, Lutz M, Waldenberger P. Sonographic detection of radial nerve entrapment within a humerus fracture.  J Ultrasound Med. 1999;  18(10) 703-706
    PubMedSearch in Google Scholar
  • 17 Bodner G, Buchberger W, Schocke M et al.. Radial nerve palsy associated with humeral shaft fracture: evaluation with US: initial experience.  Radiology. 2001;  219(3) 811-816
    CrossrefPubMedSearch in Google Scholar
  • 18 Shaw J L, Sakellarides H. Radial-nerve paralysis associated with fractures of the humerus: a review of forty-five cases.  J Bone Joint Surg Am. 1967;  49(5) 899-902
    PubMedSearch in Google Scholar
  • 19 Songcharoen P, Wongtrakul S, Mahaisavariya B, Spinner R J. Hemi-contralateral C7 transfer to median nerve in the treatment of root avulsion brachial plexus injury.  J Hand Surg [Am]. 2001;  26(6) 1058-1064
    CrossrefPubMedSearch in Google Scholar
  • 20 Kato N, Birch R. Peripheral nerve palsies associated with closed fractures and dislocations.  Injury. 2006;  37(6) 507-512
    CrossrefPubMedSearch in Google Scholar
  • 21 Sarmiento A, Zagorski J B, Zych G A, Latta L L, Capps C A. Functional bracing for the treatment of fractures of the humeral diaphysis.  J Bone Joint Surg Am. 2000;  82(4) 478-486
    PubMedSearch in Google Scholar
  • 22 Sarmiento A, Horowitch A, Aboulafia A, Vangsness Jr C T. Functional bracing for comminuted extra-articular fractures of the distal third of the humerus.  J Bone Joint Surg Br. 1990;  72(2) 283-287
    PubMedSearch in Google Scholar
  • 23 Sarmiento A, Kinman P B, Galvin E G, Schmitt R H, Phillips J G. Functional bracing of fractures of the shaft of the humerus.  J Bone Joint Surg Am. 1977;  59(5) 596-601
    PubMedSearch in Google Scholar
  • 24 Zagorski J B, Latta L L, Zych G A, Finnieston A R. Diaphyseal fractures of the humerus: treatment with prefabricated braces.  J Bone Joint Surg Am. 1988;  70(4) 607-610
    PubMedSearch in Google Scholar
  • 25 Cole P A, Wijdicks C A. The operative treatment of diaphyseal humeral shaft fractures.  Hand Clin. 2007;  23(4) 437-448
    CrossrefPubMedSearch in Google Scholar
  • 26 Livani B, Belangero W D, Castro de Medeiros R. Fractures of the distal third of the humerus with palsy of the radial nerve: management using minimally-invasive percutaneous plate osteosynthesis.  J Bone Joint Surg Br. 2006;  88(12) 1625-1628
    PubMedSearch in Google Scholar
  • 27 Jawa A, McCarty P, Doornberg J, Harris M, Ring D. Extra-articular distal-third diaphyseal fractures of the humerus: a comparison of functional bracing and plate fixation.  J Bone Joint Surg Am. 2006;  88(11) 2343-2347
    CrossrefPubMedSearch in Google Scholar
  • 28 Foster R J, Swiontkowski M F, Bach A W, Sack J T. Radial nerve palsy caused by open humeral shaft fractures.  J Hand Surg [Am]. 1993;  18(1) 121-124
    PubMedSearch in Google Scholar
  • 29 Dabezies E J, Banta II C J, Murphy C P, d'Ambrosia R D. Plate fixation of the humeral shaft for acute fractures, with and without radial nerve injuries.  J Orthop Trauma. 1992;  6(1) 10-13
    PubMedSearch in Google Scholar
  • 30 Garcia Jr A, Maeck B H. Radial nerve injuries in fractures of the shaft of the humerus.  Am J Surg. 1960;  99 625-627
    CrossrefPubMedSearch in Google Scholar
  • 31 Modabber M R, Jupiter J B. Operative management of diaphyseal fractures of the humerus: plate versus nail.  Clin Orthop Relat Res. 1998;  (347) 93-104
    PubMedSearch in Google Scholar
  • 32 Packer J W, Foster R R, Garcia A, Grantham S A. The humeral fracture with radial nerve palsy: is exploration warranted?.  Clin Orthop Relat Res. 1972;  88 34-38
    CrossrefPubMedSearch in Google Scholar
  • 33 Kettelkamp D B, Alexander H. Clinical review of radial nerve injury.  J Trauma. 1967;  7(3) 424-432
    CrossrefPubMedSearch in Google Scholar
  • 34 Ring D, Chin K, Jupiter J B. Radial nerve palsy associated with high-energy humeral shaft fractures.  J Hand Surg [Am]. 2004;  29(1) 144-147
    CrossrefPubMedSearch in Google Scholar
  • 35 Sonneveld G J, Patka P, van Mourik J C, Broere G. Treatment of fractures of the shaft of the humerus accompanied by paralysis of the radial nerve.  Injury. 1987;  18(6) 404-406
    CrossrefPubMedSearch in Google Scholar
  • 36 Bostman O, Bakalim G, Vainionpaa S, Wilppula E, Patiala H, Rokkanen P. Immediate radial nerve palsy complicating fracture of the shaft of the humerus: when is early exploration justified?.  Injury. 1985;  16(7) 499-502
    CrossrefPubMedSearch in Google Scholar
  • 37 DeFranco M J, Lawton J N. Radial nerve injuries associated with humeral fractures.  J Hand Surg [Am]. 2006;  31(4) 655-663
    CrossrefPubMedSearch in Google Scholar
  • 38 Mohler L R, Hanel D P. Closed fractures complicated by peripheral nerve injury.  J Am Acad Orthop Surg. 2006;  14(1) 32-37
    PubMedSearch in Google Scholar
  • 39 Millesi H, Meissl G, Berger A. The interfascicular nerve-grafting of the median and ulnar nerves.  J Bone Joint Surg Am. 1972;  54(4) 727-750
    PubMedSearch in Google Scholar
  • 40 Shergill G, Bonney G, Munshi P, Birch R. The radial and posterior interosseous nerves: results for 260 repairs.  J Bone Joint Surg Br. 2001;  83(5) 646-649
    CrossrefPubMedSearch in Google Scholar
  • 41 Nunley J A, Saies A D, Sandow M J, Urbaniak J R. Results of interfascicular nerve grafting for radial nerve lesions.  Microsurgery. 1996;  17(8) 431-437
    CrossrefPubMedSearch in Google Scholar
  • 42 Sunderland S. Decision making in clinical management of nerve injury and repair. In: Sunderland S Nerve Injuries and Their Repair. Edinburgh, UK; Churchill Livingstone 1991: 413-431
    Search in Google Scholar
  • 43 Burkhalter W E. Early tendon transfer in upper extremity peripheral nerve injury.  Clin Orthop Relat Res. 1974;  (104) 68-79
    CrossrefPubMedSearch in Google Scholar
  • 44 Krishnan K G, Schackert G. An analysis of results after selective tendon transfers through the interosseous membrane to provide selective finger and thumb extension in chronic irreparable radial nerve lesions.  J Hand Surg [Am]. 2008;  33(2) 223-231
    PubMedSearch in Google Scholar

Marco RizzoM.D. 

Mayo Clinic, 200 First St. SW

Rochester, MN 55905

Email: Rizzo.marco@mayo.edu