R. Belayneh1,2, K. Broder1, D. Kugelman1, P. Leucht1, S. Konda1, K. A. Egol1 1New York University School Of Medicine,Orthopaedic Surgery,New York, NY, USA 2Howard University College Of Medicine,Washington, DC, USA
Introduction: There is currently no consensus in the orthopaedic community regarding efficacy of radial nerve exploration in humeral shaft fracture repairs. According to literature, incidence of radial nerve palsy subsequent to acute humeral shaft repair hovers between 10%-20%, but there is a paucity of definitive stances of whether radial nerve exploration reduces this frequency or makes no difference. The purpose of this study is to determine the incidence and resolution of secondary radial nerve palsy in the presence of radial nerve exploration, and compare it to the radial nerve palsy incidence rate reported in literature.
Methods: Fifty-five patients were identified who underwent acute or reconstructive humeral shaft repair with radial nerve exploration as part of the primary procedure for either humeral shaft fracture or nonunion. All patients exhibited intact radial nerve function pre-operatively. A retrospective chart review and analysis identified patients who developed a secondary radial nerve palsy post-operatively. Of the 55 procedures, 38 utilized an anterolateral approach, and 17 utilized a posterior approach. In each case the radial nerve was identified and mobilized for protection, regardless of whether the implant necessitated the extensile exposure.
Results: Of the 55 patients, 2 (3.6%) developed radial nerve palsy following surgery, 1 in each approach. One patient was male and the other female. Both patients exhibited complete recovery of radial nerve function by 6 months follow up. We compared age, gender, previous history of RNP, surgical approach, fracture type, and average follow-up time between both the radial nerve palsy group and the non-radial nerve palsy group and found no significant differences (p > 0.05) in all reported variables.
Conclusion: Nerve exploration and protection in every case of humeral shaft fixation reduced the incidence of transient radial nerve palsy compared to the rate reported in the current literature (3.6% compared to 10-20%). Since nerve exploration is a relatively simple extension of the humeral shaft repair procedure and yields a significantly lower complication rate, radial nerve exploration and mobilization should be considered when approaching the humeral shaft for acute fracture and nonunion repairs.