Radial nerve palsy in humeral shaft fractures [Paresen des N. radialis bei Humerusschaftfrakturen]

Background: A frequent concomitant injury of upper arm fractures is a lesion of the radial nerve. This can occur primarily in the context of trauma or secondarily following surgical treatment of the fracture. As shown by recently published comparative analyses, there is still no consensus regarding treatment of patients with associated radial nerve palsy. The decisive factor seems to be the high rate of spontaneous remissions which cast doubt on the necessity of microsurgical revision. In contrast, about one-quarter of patients with radial nerve palsy suffer from a permanent limitation that significantly impairs the function of the hand, regardless of whether the lesion occurred primarily or secondarily. Clinical and electrophysiological follow-up and sometimes imaging techniques are necessary to avoid or reduce these long-term effects. Methods: A sample survey of patients at the Unfallkrankenhaus Berlin with fractures of the humerus surgically treated in the years 2012/2013 confirmed the frequency of accompanying radial nerve palsy as described in larger evaluations. Conclusion: In order to facilitate a timely treatment concept in an interdepartmental consensus, a flowchart was developed. Recommendations for diagnostic and therapeutic steps based on individually mapped treatment decisions are given in order to optimize outcome. © 2015, Springer-Verlag Berlin Heidelberg.