Radial nerve injury associated with humeral shaft fracture

Radial nerve palsy accompanies up to 20% of humeral shaft fractures. Two thirds of the findings occur in connection with the injury mechanism (primary palsy) and one third during conservative or surgical treatment (secondary, i.e., iatrogenic palsy). Although most of these injuries have a good prognosis and spontaneous return of function can be expected, there are situations where reinnervation cannot be achieved without surgical revision. These are lacerations or incarcerations of the nerve between bone fragments or severe traction lesions causing scarring and neuroma-in-continuity formation. Such serious findings are present in less than one half of the cases requiring surgical intervention. Early intervention has a higher success rate than conservative treatment (with possible late revision in case of persistence of denervation). Therefore, according to current literature data, early revision within 3 weeks is recommended in most cases of radial nerve palsy associated with humeral fracture with respect to the general condition of the patient, affected limb, mechanism of injury, and the results of complementary examinations.