Radial nerve gets injured in 6 to 15% of the fracture humeral shaft. Most of these palsies occur at the time of injury and would be identified at time of first evaluation. Most palsies occur at the time of the injury and are identified at initial evaluation of the fracture
10-20% of radial nerve palsies occur during the course of treatment.
Clinical Presentation
The patient would have a wrist drop in addition to humeral fracture. Patient would be unable to dorsiflex his wrist and extend metacarophalangeal joint.
A complete neurological examination must be carried out to rule out any other injury and to detrmine the level of injury.
Treatment
The patient has loss of grip strength and wrist and finger extension power. A wrist dorsiflexion splint dramatically improves grip strength and function and should be used on all patients. A functional splint with outrigger attachments to provide passive extension of the digits through rubber bands is useful.
These should be given to every patient of radial nerve palsy
Most of the patient just need to be observed while they recover uneventfully.
The time course for clinical recovery of nerve function can be estimated by measuring the distance on radiographs from the fracture to the point of innervation of the brachioradialis muscle, approximately 2 cm proximal to the lateral epicondyle. Assuming nerve recovery at 1 mm/day and adding an additional 30 days, as has been recommended, brachioradialis function after a midshaft fracture 12 cm proximal to the lateral epicondyle requires at least 100 to 130 days for recovery
Failure of appearance of clinical signs of recovery after a reasonable period of time has passed, open fractures with radial nerve palsy or palsies that worsen with treatment require exploration by surgery.
The patients where the nerve do not show any recovery are benefited by tendon transfer surgery.
Join Discussions