No prospective, randomized, clinical studies have compared early operative vs observation of

radial nerve palsies following radial shaft fractures.

Systematic Literature Review
Shao et al2 completed a systematic literature review of English and German papers published
from 1964 to 2005 that included at least 10 patients with radial nerve palsy associated with
humeral shaft fractures. They identified 44 articles that met their inclusion criteria. Two of
these articles represented the same cohort of patients, and 7 articles had insufficient data to
allow analysis. After eliminating these 9 articles, their final review included 35 observational
studies (33 published studies and 2 published abstracts).
Nine of these studies favored early exploration, 21 opposed early exploration, and 5 had
either a conditional management recommendation or did not recommend a clear treatment
preference.
While some of the studies reported solely on patients with radial nerve
palsies, 21 of the studies included the denominator of total radial shaft
fractures. In these studies, there were 532 radial nerve palsies in 4517 radial
shaft fractures; an 11.8% incidence of radial nerve palsy. Based on the
studies that described the fracture location, the highest incidence of radial
nerve palsy occurred for fractures in the distal third (Table 1). The incidence
of palsies was significantly lower for fractures located in the proximal third,
then in the middle or distal third.
Transverse and spiral fracture patterns were significantly (P<.001) more likely to be
associated with a radial nerve palsy than oblique or comminuted fractures (Table 2).
They reported no statistical difference in the incidence of radial nerve palsy in open vs closed
fractures (Table 3).2
In this literature review, which included a total of 1045 radial nerve palsies, the overall
recovery rate was 88.1% (921/1045). No significant difference in the recovery rate between
primary (occurring at the time of injury) and secondary (occurring after the injury, or as a
result of a closed reduction) nerve palsies was reported (Table 4). The mean time to onset of
recovery, reported in only 5 studies that included 101 patients, was 7.3 weeks (range, 2 weeks
to 6.6 months). Mean time to full recovery, reported in only 5 studies that included 110
patients, was 6.1 months (range, 3.4-12 months).
What the Literature Says About Various Scenarios
The following section will review common scenarios relating to radial nerve palsy associated
with humeral shaft fractures.
Open Fractures
Several authors have reported that radial nerve transaction is usually associated with an open
fracture.4,5 Foster et al4 reported on a series of 14 patients with radial nerve palsy and open

humeral shaft fracture. Exploration of the nerve revealed that 9 (64%) of the 14 nerves were
either lacerated or interposed between the fracture fragments. They reported that epineural