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Abstract
Materials and Methods
We reviewed 107 paients with humeral shaft fracture between January 2000 and June 2007. Thirteen patients had radial nerve palsy after trauma and 9 patients after the operation. We analyzed contributing factors of radial nerve palsy associated with humeral shaft fracture including the cause of trauma, location and pattern of fracture, surgical approach and tourniquet application in cases of plate fixation, the exploration for the nerve and the time for operation.
Results
The difference in the incidences of radial nerve palsy after trauma and operation was not significant according to the location and pattern of fracture. The tendency of higher rate of radial nerve palsy after trauma in oblique or comminuted fractures, and after operation in spiral fractures was observed. The operation using intramedullary nailing and radial nerve exploration significantly reduced the incidence of radial nerve palsy after operation (p=0.01 and p=0.02). Posterior approach in open reduction and plate fixation showed a tendency of lower incidence of radial nerve palsy after operation (p=0.78). In logistic regression analysis, radial nerve exploration was the only significant factor that reduced the possibility of radial nerve palsy after operation (17.27: odds ratio, p=0.02).
Conclusion
In humeral shaft fractures, we should take into consideration whether intramedullary nailing is possible or not. In cases of anterior or anterolateral approach of open reduction and plate fixation, radial nerve should be carefully inspected. In most cases, we recommend radial nerve exploration in order to minimize the possibility of radial nerve palsy after operation.
Figures and Tables
Fig. 1
(A) Pre-operative, (B) post-operative and (C) final anteroposterior radiographs of a spiral distal humeral shaft fracture in a 30-year-old man following operative treatment with open reduction and plate fixation was shown. The radial nerve palsy developed after the operation and recovered in 6 weeks after the operation.
Table 1
Fracture site and post-traumatic or post-operative radial nerve palsy
Fisher's exact test, Proximal: from surgical neck to the proximal 1/3 portion of diaphysis, Proximal 1/3: junctional portion between proximal segment and midshaft, Midshaft: from the proximal 1/3 to the proximal 2/3 portion of diaphysis, Distal 1/3: junctional portion between midshaft and distal segment, Distal: from the proximal 2/3 portion of diaphysis to just above medial and lateral epicondyle.
References
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