Radial nerve injuries in humeral fractures: case series and medico-legal implications.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Declaration of competing interest The authors declare no conflict of interest. 7. Orthop Traumatol Surg Res. 2015 Feb;101(1 Suppl):S41-9. doi: 10.1016/j.otsr.2014.07.034. Epub 2015 Jan 17. Acute and chronic humeral shaft fractures in adults. Pidhorz L(1). Author information: (1)Centre hospitalier du Mans, 194, avenue Rubillard, 72037 Le Mans cedex 9, France. Electronic address: lpidhorz@ch-lemans.fr. Humeral shaft fractures account for up to 5% of all fractures. Many of these fractures are still being treated conservatively using functional (Sarmiento) bracing or a hanging arm cast. Union is achieved in 10 weeks in more than 94% of cases. Angulation of less than 30° varus or valgus and less than 20° flessum or recurvatum can be tolerated by the patient from a functional and esthetic point of view. The ideal candidate for this treatment is a patient with an isolated fracture. Plate and screw fixation of the fracture results in union in 11 to 19 weeks. Reported complications include non-union (2.8-21%), secondary radial nerve palsy (6.5-12%) and infection (0.8-2.4%). Anterograde or retrograde locked intramedullary nailing requires knowledge of nailing techniques and regional anatomy to avoid the complications associated with the technique. Union is obtained in 10-15 weeks. Reported complications consist of non-union (2-17.4%), infection (0-4%) and secondary radial nerve palsy (2.7-5%). Hackethal bundle nailing is still used for fracture fixation, despite an elevated complication rate (5-24% non-union and 6-29% pin migration) because of its low cost and simple instrumentation. Union is achieved in 8-9 weeks. Controversy remains about the course to follow when the radial nerve is injured initially. If the fracture is open, significantly displaced, associated with a vascular injury or requires surgical treatment, the nerve must be explored. In other cases, the recommended approach varies greatly. Conservative treatment is inexpensive and has a low complication rate. Humeral shaft fractures are increasingly being treated surgically, at a greater cost and higher risk of complications. Copyright © 2015 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2014.07.034