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What About the Children? Incidence of Radial Nerve Palsy in Pediatric Humeral Shaft Fractures
Maureen A O'Shaughnessy, MD; Todd Milbrandt, MD; Laura Lewallen, MD; Kapil Mehrotra, MD; A Noelle Larson, MD
Mayo Clinic, Rochester, MN

Introduction: Humeral shaft fractures complicated by radial nerve palsy continue to be an important injury in the adult population with an average incidence of 11.8%; debate is ongoing regarding their optimal management. In the pediatric population, humeral shaft fractures are less common and little information exists regarding the incidence or management of radial nerve palsy in pediatric humeral shaft fractures. This study aims to evaluate incidence and outcomes of radial nerve palsy in pediatric humeral shaft fractures.

Methods: IRB-approved retrospective study reviewed pediatric patients treated for humeral shaft fracture between 1996-2016. At latest follow up data including fracture characteristics, operative vs nonoperative management, complications and outcomes were recorded.

Results: The series includes 100 patients (32 female, 68 male) with average age at injury of 10 (range 0-17). Average follow up was 34 months (range 2-181) excluding 7 patients deceased from inciting trauma. Fractures in this series were 65 type AO 12A, 13 type 12B and 2 type 12C. Location included proximal (6), middle (72), middle/distal junction (6) and distal third (16). Final fracture treatment consisted of nonoperative (70 patients) and operative (30) management. Humeral shaft fractures complicated by radial nerve palsy continue to be an important injury in the adult population with an average incidence of 11.8%; debate is ongoing regarding their optimal management. Overall, any nerve injury was noted in 8/100 patients including radial (5), ulnar (1), median (1) and mixed radial, ulnar and median nerve symptoms (1) giving an overall incidence of radial nerve palsy of 6%. 8/8 patients with nerve injury had closed injuries. 3/8 patients with nerve injury underwent closed reduction and fixation with flexible nailing. All were treated expectantly with no patient undergoing operative nerve exploration in this series. Incidence of nerve palsy was slightly higher in males (8.8%) vs females (6.4%). Average age of patients with nerve lesion was slightly higher (14 vs 10 years old). Nerve injury was noted in fractures only in the middle, middle/distal, or distal location with no injuries in the proximal third. Nerve recovery was noted in 8/8 patients at an average time to full recovery of 133 days (range 2-378). Average time to onset of recovery was 47 days (range 0.25-145). Median and ulnar nerve palsies showed earlier recovery with average onset of recovery 1 day (range 0.25-2) and average full recovery 3 days (range 2-4).

Discussion and conclusion: This study is significant as it is the first to define the incidence (6%) and outcomes (full recovery in all) of radial nerve palsy in pediatric humeral shaft fractures.


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