8/20/2019 No Prospective

1/2

 No prospective, randomized, clinical studies have compared early operative vs observation of 

radial nerve palsies following radial shaft fractures.

Systematic Literature Review

Shao et al2 completed a systematic literature review of English and German papers published

from 1!" to 2##$ that included at least 1# patients with radial nerve palsy associated with

humeral shaft fractures. %hey identified "" articles that met their inclusion criteria. %wo of

these articles represented the same cohort of patients, and & articles had insufficient data to

allow analysis. 'fter eliminating these articles, their final review included ($ observational

studies )(( published studies and 2 published abstracts*.

 Nine of these studies favored early e+ploration, 21 opposed early e+ploration, and $ had

either a conditional management recommendation or did not recommend a clear treatment

 preference.

hile some of the studies reported solely on patients with radial nerve

 palsies, 21 of the studies included the denominator of total radial shaft

fractures. -n these studies, there were $(2 radial nerve palsies in "$1& radial

shaft fractures an 11./0 incidence of radial nerve palsy. ased on the

studies that described the fracture location, the highest incidence of radial

nerve palsy occurred for fractures in the distal third )%able 1*. %he incidence

of palsies was significantly lower for fractures located in the pro+imal third,

then in the middle or distal third.

%ransverse and spiral fracture patterns were significantly ) P 

.##1* more li3ely to beassociated with a radial nerve palsy than obli4ue or comminuted fractures )%able 2*.

%hey reported no statistical difference in the incidence of radial nerve palsy in open vs closed

fractures )%able (*.2 

-n this literature review, which included a total of 1#"$ radial nerve palsies, the overall

recovery rate was //.10 )2151#"$*. No significant difference in the recovery rate between

 primary )occurring at the time of in6ury* and secondary )occurring after the in6ury, or as a

result of a closed reduction* nerve palsies was reported )%able "*. %he mean time to onset of

recovery, reported in only $ studies that included 1#1 patients, was &.( wee3s )range, 2 wee3s

to !.! months*. 7ean time to full recovery, reported in only $ studies that included 11# patients, was !.1 months )range, (."812 months*.

What the Literature Says About Various Scenarios

%he following section will review common scenarios relating to radial nerve palsy associated

with humeral shaft fractures.

Open Fractures

Several authors have reported that radial nerve transaction is usually associated with an open

fracture.",$ 9oster et al" reported on a series of 1" patients with radial nerve palsy and open

8/20/2019 No Prospective

2/2

humeral shaft fracture. E+ploration of the nerve revealed that )!"0* of the 1" nerves were

either lacerated or interposed between the fracture fragments. %hey reported that epineural