Humerus shaft fracture complicated by radial nerve palsy: Is surgical exploration necessary?

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Abstract

[Indexed for MEDLINE] 10. Ortop Traumatol Rehabil. 2022 Jun 30;24(3):201-207. doi: 10.5604/01.3001.0015.9063. Radial Nerve Palsy in Paediatric Humeral Shaft Fractures: Incidence and Management. Wiktor Ł(1), Tomaszewski R(2). Author information: (1)Górnośląskie Centrum Zdrowia Dziecka, Oddział Urazowo-Ortopedyczny, Katowice-Ligota, Polska / Upper Silesian Children's Health Centre, Department of Trauma and Orthopaedic Surgery, Katowice-Ligota, Poland. (2)Uniwersytet Śląski w Katowicach / Faculty of Science and Technology Wydział Nauk Ścisłych i Technicznych, Instytut Inżynierii Biomedycznej, Chorzów, Polska / Institute of Biomedical Engineering, University of Silesia in Katowice, Katowice, Poland. BACKGROUND: Humeral shaft fractures are relatively rare in the paediatric population. The purpose of our study was to retrospectively evaluate all humeral shaft fractures treated at a children's trauma centre and assess cases involving radial nerve injury. MATERIAL AND METHODS: We retrospectively evaluated a group of 5 skeletally immature patients with radial nerve palsy out of a total of 104 patients with humeral shaft fractures treated in our hospital between January 2011 and December 2021. RESULTS: The study group consisted of four boys and one girl aged 8.6 to 17.2 years (average age 13.6). Mean follow-up duration was 18.4 months. We diagnosed two open and three closed fractures. There were two cases of neurotmesis, two cases of nerve entrapment within the fracture site and one case of neuropraxia. Bone union and functional recovery was achieved in all five patients. CONCLUSIONS: 1. Humeral shaft fractures complicated with radial nerve palsy are a challenging medical problem; 2. The incidence of radial nerve injury in the paediatric population is significantly lower than in adults; in our study, it accounted for 4.8% of all humeral shaft fractures; 3. Expectant observation without nerve exploration is reasonable in fractures caused by a low-energy trauma; 4. Early surgical nerve exploration combined with fracture stabilisation is highly recommended in fractures due to a high-energy trauma. DOI: 10.5604/01.3001.0015.9063