An Updated Systematic Review of Radial Nerve Palsy Rate and Recovery after Fractures of the Humerus: Is Non-Operative Treatment Still Better
John Mangan, MD; Jack G Graham, BS; Asif Ilyas, MD
Rothman Institute at Thomas Jefferson University, Philadelphia, PA
A prior systematic review by Shao et al. published in 2005, based on studies published between 1964 to 2004, identified an overall radial nerve palsy rate of 11.8% after fractures of the humeral shaft, with a spontaneous recovery rate of 70.7%, and purportedly no difference found between cases treated with early surgery versus expectant treatment. However, the authors combined non-surgical and delayed surgical treatment both into the "expectant" category to make this conclusion. Therefore, to better understand our current understanding of the radial nerve palsy rate and recovery potential simply with and without surgical exploration, an updated systematic review was undertaken focusing on modern technique and more contemporary outcomes.
A systematic review of all published literature was undertaken. An electronic database search was performed to identify publications that met specific inclusion criteria. We identified 23 articles published since 2000 or later that met our eligibility requirements. Data was carefully abstracted from these articles and analyzed independently as well as collectively with the results of the Shao et al. systematic review.
The prevalence of primary radial nerve palsy was 12.3% (890/7262) after humeral shaft fractures. Patients treated non-operatively had a rate over recovery of 77.2%. Patients who failed non-operative management and later underwent nerve exploration more than 8 weeks after their injury had a rate of recover of 68.1%. In contrast, patients treated with early surgery, within 3 weeks of the injury, had a rate of recovery of 89.8% (p <0.001).
From published data from 2000 onward, patients that underwent early surgical exploration and fracture repair within 3 weeks of injury had a statistically higher likelihood of regaining radial nerve function than patients that underwent non-operative management, with or without later surgical exploration. Based on this updated systematic review utilizing contemporary data and techniques, we would recommend moving beyond the dogma of simply observing radial nerve palsies and consider early surgical exploration for radial nerve palsies following fractures of the humeral shaft.
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