Radial Nerve Paralysis Associated with Fractures of the Humerus

Sixty-two patients with radial nerve paralysis associated with fractures of the humerus were reviewed. Seventy-three per cent of the patients had primary radial nerve paralysis and 27% had secondary paralysis. Conservative management has led to excellent nerve recovery in all groups of patients. Overall, 95% of the patients with radial nerve paralysis recovered normal or near normal function. All patients with secondary paralysis had full functional recovery of the radial nerve. Conservative management is recommended in patients with radial nerve paralysis associated with fractures of the humerus, regardless of age of the patient, cause of injury, level of fracture, type of fracture, and whether paralysis is primary or secondary. Use of dynamic splints and exercises, to keep all joints of the hand and wrist supple, should be an integral part of the treatment. Indications for early surgery are unacceptable fracture reduction, open fractures requiring debridement, and associated vascular injuries. In all open procedures, the radial nerve should be explored at the same time and treated appropriately. EMG studies are recommended at four and six months. If there Is no evidence of recovery, the nerve should be explored. Except in unequivocal irreparable radial nerve damage, tendon transfers should be deferred for at least six months, preferably for one year. The possible effect of entrapment of nerve by scar and callus remains to be established.