Management of Radial Nerve Palsy Following Fractures of the Humerus

Radial nerve palsy is the most common peripheral nerve injury following a humerus fracture, occurring in 2% to 17% of cases. Radial nerve palsies associated with closed humerus fractures have traditionally been treated with observation, with late exploration restricted to cases without spontaneous nerve recovery at 3 to 6 months. Advocates for early exploration believe that late exploration can result in increased muscular atrophy, motor endplate loss, compromised nerve recovery upon delayed repair, and significant interval loss of patient function and livelihood. In contrast, early exploration can hasten nerve injury characterization and repair, and facilitate early fracture stabilization and rehabilitation.

Key points

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A radial nerve palsy is the most common peripheral nerve injury following a humerus fracture, occurring in up to 2% to 17% of cases.
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Surgical exploration is recommended in cases with open or complex fractures, particularly those associated with penetrating trauma.
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Radial nerve palsies associated with closed fractures of the humerus have traditionally been recommended to be treated with observation, with late exploration restricted to cases without spontaneous nerve recovery at 3 to 6 months.
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Advocates for early exploration believe that late exploration can result in increased muscular atrophy, motor endplate loss, compromised nerve recovery on delayed repair, and significant interval loss of patient function and livelihood.
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Early exploration can hasten nerve injury characterization and repair, as well as facilitate early fracture stabilization and rehabilitation.