Treatment of humeral fracture associated with radial nerve injury

Objective To study the causes and outcome of humeral fracture associated with radial nerve injury. Methods 43 cases of humeral fractures associated with radial nerve injuries were enrolled, including 5 cases of iatrogenic radial nerve injuries. The treatment methods were closed reduction and external stabilization for 6 cases and open reduction and internal fixation for 37. Intraoperative findings included complete radial nerve rupture in 8 cases (1 avulsion), contusion in 18, scar compression in 4 and fragment entrapment in 2. The operations were performed with radial nerve scar release in 4 cases, epineural terminal-terminal anasmatosis for 7 (with 3 humeral shortening osteotomies), and neural graft for radial nerve defect repair with forearm lateral cutaneous nerve for 1. Results The humeral fractures healed in 6~12 weeks. In 1~24 months follow-up, the radial nerve function recovery was excellent (S~+_3, over M_4) in 36 cases, good (S_3, M_3) in 6, and poor (S_1, M_1) in 1. The excellent and good rate was 97.7%. Conclusions Satisfactory outcome can be obtained in the radial nerve injury in humeral shaft. The operation should be preformed as early as possible, and neural transplantation shouldnt be concerned when humeral shortening osteotomy is possible. The prevention and treatment of iatrogenic radial nerve injury shoulded be cautioned.