Study of Incidence and Treatment of Radial Nerve Palsy in Fracture Shaft of Humerus

Introduction: A radial nerve injury associated with a humeral shaft fracture is an important injury pattern among trauma patients. It is the most common peripheral nerve injury associated with this fracture. Injuries to the radial nerve can result in significant motor impairment of the arm and the wrist with the loss of wrist extension, the ability to grasp is significantly reduced leading to a serious handicap. Objective: To find out the incidence of radial nerve palsy in case of fracture shaft of humerus. To analyze results of various modalities of treatment of fracture shaft of humerus associated with radial nerve injury; To establish a probable guideline for the treatment of radial nerve injuries in fracture of the shaft of humerus. Method: This is a prospective study of 80 patients with closed and open diaphyseal fracture of Humerus with 20 complete primary radial nerve palsy and 5 secondary nerve palsy treated in Government Wenlock Hospital, K.M.C. and associated Hospitals, Mangalore during the period from January 2004 to September 2006. Result: A total of 80 patients of fracture shaft of humerus were analyzed in this study with 20 immediate and 5 secondary radial nerve palsy. The youngest patient was 20 years and the oldest was 70 years old. Majority of the patient were in 21 - 40 years of age. Radial nerve palsy was more commonly seen in fractures involving the middle third of Humeral shaft P(0.004). The incidence of radial nerve palsy was highest in patients with oblique fracture and average time of recovery was 22 weeks. All the cases that were explored showed the nerve to be in continuity and no surgical repair of the radial nerve was required P(0.831). Radial nerve palsy associated with upper third fracture recovers faster; though it needs to be further confirmed as the sample size was small. Conclusion: The outcome of radial nerve palsy was not found to be related to age group, sex, side, mechanism of injury, intra-operative condition of nerve, method of treatment of fracture and time of exploration of radial nerve. Recommendation: Our study recommends a conservative and expectant line of management for both primary as well as secondary nerve palsies. As complete recovery of the nerve can be quite delayed, patience is merited before considering tendon transfers.