Humeral shaft fractures

Humeral shaft fractures are relatively common, representing approximately 1% to 5% of all fractures. Conservative management is the treatment of choice for most humeral shaft fractures and offers functional results and union rates that are not inferior to surgical management. Age and oblique fractures of the proximal third are risk factors for nonunion. Surgical indication threshold should be lower in patients older than 55 years presenting with this type of fracture. Functional outcomes and union rates after plating and intramedullary nailing are comparable, but the likelihood of shoulder complications is higher with intramedullary nailing. There is no advantage to early exploration of the radial nerve even in secondary radial nerve palsy. Cite this article: EFORT Open Rev 2021;6:904-914. DOI: 10.1302/2058-5241.6.200033

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Humeral shaft fractures and radial nerve palsy: early exploration findings

Joint Diseases and Related Surgery ◽

10.5606/ehc.2016.08 ◽

2016 ◽

Vol 27 (1) ◽

pp. 41-45 ◽

Cited By ~ 5

Author(s):

Ali Çağdaş Yörükoğlu

Keyword(s):

Radial Nerve ◽

Nerve Palsy ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Early Exploration

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Secondary radial neuropathy after closed intramedullary nailing of humeral shaft fractures. Results over a 10-year period

Acta Orthopaedica Belgica ◽

10.52628/87.3.15 ◽

2021 ◽

Vol 87 (3) ◽

pp. 495-500

Author(s):

Anton Ulstrup

Keyword(s):

Intramedullary Nailing ◽

Radial Nerve ◽

Nerve Palsy ◽

Humeral Shaft ◽

Radial Nerve Palsy ◽

Nerve Paralysis ◽

Nerve Lesions ◽

Humeral Shaft Fractures ◽

Shaft Fractures ◽

Closed Intramedullary Nailing

Background. Retrospective study to examine secondary radial nerve palsy after humeral shaft fixation with closed locked intramedullary nailing. Materials and methods. Patients were identified from the hospitals’ registration systems for humeral shaft fractures, nerve lesions, plating, nailing and external fixation during a 10-year period from January 2007 to December 2016. All radial nerve lesions were registered and followed-up in patient files. Results. 89 patients with locked intramedullary nailing were available for an outpatient follow-up. Mean age was 67 years at the time of injury. 72 fractures were non-pathological. Of these, 31 were nonunions. 28, 61 and zero were identified in the proximal, middle and distal thirds of the humeral shaft respectively. 76 procedures were closed and 13 were with open reduction. Six radial nerves had nerve exploration. Eight patients developed immediate postoperative radial nerve palsies. Of these, six developed after closed surgery, two after nerve exploration. Of seven available patients with a radial nerve palsy, six of these remitted. Two patients were later surgically explored. One patient out of 89 sustained a verifiable permanent radial nerve paralysis. Conclusions. In this study, the risk of a radial nerve palsy was 7.9 % with closed locked intramedullary nailing. This study suggests that exploration of the radial nerve is not necessary routinely in order to prevent radial nerve lesions when performing closed intramedullary nailing for humeral shaft fractures in adults with a preoperative normal radial nerve function. Level of Evidence : Level IV.

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