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Radial nerve palsy in mid/distal humeral fractures: is early exploration effective?
Author(s) -
Keighley Geffrey,
Hermans Deborah,
Lawton Vidya,
Duckworth David
Publication year - 2018
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.14259
Subject(s) - medicine , radial nerve , surgery , palsy , wrist , internal fixation , humerus , decompression , axillary nerve , fixation (population genetics) , median nerve , anesthesia , brachial plexus , population , alternative medicine , environmental health , pathology
Background Radial nerve palsies are a common complication with displaced distal humeral fractures. This case series examines the outcomes of early operative exploration and decompression of the nerve with fracture fixation with the view that this provides a solid construct for optimisation of nerve recovery. Methods A total of 10 consecutive patients with a displaced distal humeral fracture and an acute radial nerve palsy were treated by the senior author by open reduction and internal fixation of the distal humerus and exploration and decompression of the radial nerve. Motor function and sensation of the radial nerve was assessed in the post‐operative period every 2 months or until full recovery of the radial nerve function had occurred. Results All patients (100%) had recovery of motor and sensation function of their upper limb in the radial nerve distribution over a 12‐month period. Recovery times ranged between 4 and 32 weeks, with the median time to recovery occurring at 26 weeks and the average time to full recovery being 22.9 weeks. Wrist extension recovered by an average of 3 months (range 2–26 weeks) and then finger extension started to recover 2–6 weeks after this. Disability of the arm, shoulder and hand scores ranged from 0 to 11.8 at greater than 1 year post‐operatively. Discussion Our study demonstrated that early operative exploration of the radial nerve when performing an open stabilization of displaced distal humeral fractures resulted in a 100% recovery of the radial nerve.