Outcome of Radial Nerve Palsy in Closed Humeral Shaft Fractures Treated Operatively and Expectantly.

PURPOSE: Recent trends favor earlier surgical intervention for humeral shaft fractures, based on the idea that operatively treated humerus fractures with associated radial nerve palsy may result in an earlier return of nerve function. The primary aim of this study was to evaluate whether the timing of radial nerve recovery differs between patients managed expectantly and operatively.

METHODS: A retrospective review of closed humeral shaft fractures over a 12-year period was conducted. Patients with an associated radial nerve palsy were identified. Analysis focused on the time to onset of radial nerve motor recovery.

RESULTS: A total of 15 patients with humeral fractures with radial nerve palsy were included in the final cohort: eight were treated with expectant management and seven underwent acute open reduction internal fixation. All patients exhibited complete radial nerve recovery within 53 weeks. The mean onset of initial radial nerve recovery was 8.4 weeks, with full recovery achieved at an average of 32.6 weeks. Statistical analysis demonstrated no significant difference in the onset of (6.4 vs 10.8 weeks; P = .28) and full (35.7 vs 29.9 weeks; P = .6) recovery between patients treated conservatively and operatively.

CONCLUSIONS: Radial nerve palsy associated with closed humeral shaft fractures have a high rate of spontaneous nerve recovery, with similar onset and full recovery of nerve function despite the treatment option chosen. Closed humeral shaft fractures with concomitant radial nerve palsy should not be an indication for operative treatment with the aim of decreasing the time to nerve recovery.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.