Distal Humerus-Radial Nerve Injuries Associated WithHumeral Fractures

Radial Nerve Injuries Associated WithHumeral Fractures

Pdf Summary

Radial nerve injuries associated with humeral fractures are a common peripheral nerve injury. The management of this injury is a controversial subject among upper-extremity surgeons. However, certain management principles should be applied in all cases. The pathoanatomy of the humerus and surrounding neurovascular structures has evolved over time, leading surgeons to adapt their strategies in order to improve outcomes and avoid long-term morbidity. Treatment strategies and clinical outcomes have been defined in the literature, and a review of these is provided. Humeral shaft fractures account for about 3-5% of all fractures, with over 237,000 cases occurring annually in the US. Recent studies have shown that these fractures are occurring more frequently in women over the age of 50 due to moderate trauma such as a fall from a standing position, while historically they were more common among young males. Despite this changing epidemiology, radial nerve injuries continue to be the most common peripheral nerve injury associated with humeral fractures, occurring in about 2-17% of cases. The incidence of radial nerve injury is higher in fractures of the middle third of the humerus and fractures of the distal third of the humerus. Treatment of humeral shaft fractures with radial nerve injury is controversial, with some surgeons advocating for surgery and nerve exploration while others recommend expectant management. The decision to pursue surgery depends on various factors such as open fractures, vascular injury, high-velocity gunshot wounds, nerve laceration, and severe soft tissue injury. Nerve repair techniques include neurorrhaphy, nerve grafting, nerve transfers, and tendon transfers. Management of radial nerve injury includes no exploration, early exploration, and late exploration. The decision to proceed with exploration is based on various factors such as open fracture, nerve deficit after closed reduction, high suspicion of nerve laceration, and severe soft tissue injury. The prognosis for nerve recovery is higher after early surgical exploration.

Keywords

radial nerve injuries

humeral fractures

peripheral nerve injury

management

upper-extremity surgeons

pathoanatomy

neurovascular structures

treatment strategies

clinical outcomes

humeral shaft fractures