[Functional outcomes of radial nerve palsy associated with humeral fractures using microscopic nerve repair procedures]

ABSTRACT

Radial Nerve Palsy [RNP] is the most common nerve lesion complicating humeral shaft fractures in 2%-17% of cases. Exploration timing [early or delayed] and various nerve repair procedures are still matter of dispute. The objective of this study is to determine the functional treatment outcome of microsurgeric repair of RNP associated with humeral fractures. In this retrospective study of 20 patients [15 males and 5 females with a mean age of 35 +/- 12.5] with humeral fractures, 15 cases had primary RNP and t he other 5 cases experienced nerve palsy after their orthopedic manipulations [secondary or iatrogenic RNP]. Of the first 15 patients, 7 cases had open humeral fractures which were treated using ORIF and early exploration procedures and 8 cases with closed humeral fractures treated conservatively with closed reductioncasting and delayed exploration after 3months because of no recovery. Iatrogenic RNP were observed for 3 months and explored after no sign of recovery. Nerve repair procedures were performed based on nerve injury and patients were followed up for a mean of 24.4 +/- 2.5 months [19-20 months]. Exploration findings, kind of nerve repair and functional recovery rate [based on Alnot criteria] were recorded and analyzed using SPSS-19 software. Of the 7 cases who suffered from total radial nerve transection [repaired by interfasicular grafting] 3 cases had good outcome, 2 cases had fair outcome and 2 cases were failed. Exploration of 3 cases revealed partial nerve tearing [repaired by neurorrhaph y] with good results. Eight cases with perineural fibrosis and 2 cases of nerve entrapment in callus were treated by interfasicular neurolysis and the results were good. Overall recovery rate of these three procedures was 90%. In patients with RNP associated with humeral fractures, choosing proper microsurgeric nerve repair and determining proper exploration timing [early or delayed] could result in desirable functional outcomes: