Humeral shaft fractures and radial nerve palsy: early exploration findings
Ali Çağdaş Yörükoğlu1, A. Fahir Demirkan1, Nihal Büker2, Alp Akman1, Nusret Ok1
1Department of Orthopedics and Traumatology, Medical Faculty of Pamukkale University, Denizli, Turkey
2Department of Orthopaedic Physiotheraphy, School of Physical Theraphy and Rehabilitation, Pamukkale University, Denizli, Turkey
Keywords: Humeral fracture, nerve contusion, peripheral nerve injuries, radial neuropathy.
Objectives: This study aims to present the results of early nerve explorations in cases with radial nerve palsy associated with humeral shaft fracture and to investigate in which cases early nerve explorations may be beneficial.
Patients and methods: Twenty-four patients (17 males, 7 females; mean age 36 years; range 18 to 72 years) with complete sensory and motor radial nerve damage associated with humeral shaft fracture were retrospectively analyzed. The patients with high-energy trauma and the ones who had spiral and segmental fractures with low energy traumas were included in the study. Early nerve exploration was performed in all patients within an average of 4.8 days (range 1 to 20 days) after fracture development. Electrophysiological assessments were performed in cases with no neurological recovery until 12th week.
Results: Spiral fractures of the humerus shaft observed in 14 (58.3%) of the 24 operated patients were the most common fracture type, followed by transverse fracture in four patients (16.6%) and comminuted fracture in two patients (8.3%). As a result of the exploration, we observed nerve compression between the fracture fragments in seven patients (29.1%); a majority of these patients (n=6) had spiral fractures of humerus and one patient had comminuted fracture. One patient with a spiral type fracture had nerve transection. Radial nerve function recovered in most of the patients (95.8%). Average duration for fracture union was 6.7±3.8 months (range 3 to 18 months).
Conclusion: Spiral fractures of humerus, particularly with wedge fragment, may be a candidate for early surgical exploration. Early exploration may be beneficial in terms of early identification of neural injury in patients with radial nerve dysfunction associated with spiral and comminuted humerus fracture.