Diaphyseal fractures of the humerus with radial nerve injury: how to manage both fracture and the nerve injury

In this article, data of nerve and bone recovery were reported in a series of patients treated with open reduction and internal fixation (ORIF) with plate in humeral shaft fractures (HSF) associated with radial nerve palsy (RNP). The authors highlight the role of early surgical intervention for optimal nerve repair and patient's recovery, and to avoid subsequent and more complex surgery to patients. This is a retrospective study of 24 of 31 patients with HSF with RNP (10,1%) out of 308 patients with HSF, treated surgically between 2012 and 2023 in a level I Trauma Center. The mean age was 57 years. The mean follow-up time was 42 months (range 12-60). Twenty-seven were closed fractures and 4 were open. All patients were treated within 24 hours with ORIF with plate and exploration and decompression of radial nerve. The medical records of all patients and their X-ray were reviewed to evaluate fracture's type, location, energy of trauma, status of RN injury and, beyond the time of recovery from RNP, the time of bone healing and functionally recovery. We reviewed 24 patients, and 7 were lost to follow-up. All patients (100%) had good nerve palsy recovery in a mean time of 6.2 months. The mean X-ray bone consolidation occurred after 4 months. The mean time of Rom recovery was 4.46 months. None of our patients needed further surgery for the failure of the radial nerve recovery. In conclusion, our study, even of mall size, demonstrated that early surgical exploration of radial nerve during ORIF with plate of RHSF facilitates nerve repair and enhancing patient recovery. Furthermore, the low incidence of radial nerve palsy should not preclude surgical exploration, conversely, as many patients may have undiagnosed nerve injuries that can be addressed through timely intervention.