Hak, D.J. 2008. Radial Nerve Palsy Associated With Humeral Shaft Fractures . Colorado.

http://www.orthosupersite.com/view.aspx?rid=36779 pada tanggal 28 Februari 2012

Radial Nerve Palsy Associated With Humeral Shaft Fractures
by David J. Hak, MD, MBA
Radial nerve palsy frequently accompanies humeral shaft fractures. The need for operative
exploration in different situations continues to be debated.
Radial nerve palsy associated with radial shaft fracture is a common occurrence.
Approximately 1 in 10 patients with a humeral shaft fracture will also have associated radial
nerve palsy. In an epidemiologic study of 1.4 million people, the overall incidence of radial
nerve palsy in 401 humeral shaft fractures was 8.5%.1 In a systematic literature review, Shao
et al2 identified 532 radial nerve palsies in 4517 radial shaft fractures; an 11.8% incidence of
radial nerve palsy.
The management of radial nerve palsy associated with a humeral shaft fracture is a topic of
debate. Although it is known that the majority of these injuries are neuropraxias that will
recover spontaneously, the indication and need for operative exploration has been disputed,
with authors offering conflicting opinions.
While some surgeons have advocated different treatment algorithms for radial nerve palsies
that occur secondary to a closed fracture reduction, others believe that the timing of the nerve
palsy is irrelevant to the management decision.
Primary nerve palsies occur at the time of injury and are discovered during the patients initial
evaluation. Approximately 10% to 20% of nerve palsies develop during the course of
treatment, commonly noted following a closed reduction, and are termed secondary nerve
palsies.3 Complete motor loss is present in 50% to 68% of cases of radial nerve palsy, while
the others are only partial motor loss or sensory loss.3
Surgeons advocating early operative exploration of radial nerve palsy cite several advantages,
including:

The surgical dissection is technically easier and safer when done acutely.

Fracture fixation decreases the risk of further nerve damage that could occur due to
continued fracture site motion.

If shortening of the bone is required to obtain a primary repair, then it is better done
prior to fracture healing.

Fracture reduction and fixation reduces the risk of the nerve becoming entrapped in
callus formation.

The degree of nerve injury is identified, clarifying the anticipated future treatment and
outcome for the patient.

Surgeons advocating observation of radial nerve palsy cite the following opposing
viewpoints:

There is a high rate of expected recovery.

Observation eliminates unnecessary surgery.

The nerve injury is easier to treat after the fracture is healed.

Ultimate outcome is equally good with late vs early repair.