Article

Radial nerve injury is common in humeral shaft fractures and fails to
recover spontaneously in 30% of cases. Few studies have evaluated predictors of
recovery. The objectives of this study were to identify predictors of radial
nerve palsy recovery and to assess the usefulness of surgical radial nerve
exploration in patients with preoperative radial nerve palsy. HYPOTHESIS: Factors
predicting the outcome of radial nerve palsy can be identified. METHODS: Of 373
patients with humeral shaft fractures between 2005 and 2012, 43 had radial nerve
palsy, including 23 who were lost to follow-up and 17 who were evaluated
retrospectively at a mean of 26 months (range, 12-84 months) after internal
fixation. The following were studied: age, smoking history, energy of the trauma,
fracture type and displacement, skin integrity and intra-operative appearance of
the radial nerve. RESULTS: Of the 17 palsies, 13 were present preoperatively,
including 10 that recovered (PreR group) and 3 that did not recover (PreNR
group). Plate fixation and radial nerve exploration were performed in all
patients. Of the 10 PreR patients, 6 had nerve contusion and 2-nerve entrapment.
Of the 3 PreNR patients, 2 had gross nerve damage and 1 nerve contusion and a
history of spinal muscular atrophy. Only age and presence of gross nerve damage
differed significantly between the PreR and PreNR groups; trends towards
significant differences were noted for skin breach and fracture displacement. Of
the 4 postoperative radial nerve palsies, 2 recovered fully and 2 partially; mean
age was higher in the 2 patients with partial recovery. DISCUSSION: These
findings are consistent with the few previous studies of outcome predictors in
radial nerve palsy. Factors such as major fracture displacement and high-grade
skin wounds probably promote the occurrence of gross nerve lesions. The high
incidence of nerve entrapment and stretching supports routine nerve exploration
during internal fixation in patients with preoperative radial nerve palsy. LEVEL OF EVIDENCE: IV, retrospective study with no control group.
CI - Copyright (c) 2016. Published by Elsevier Masson SAS.

Langue : FRANCAIS