Humerus Fracture with Radial Nerve Palsy, Part 1

Chuck and Chris discuss a radial nerve palsy associated with a humerus fracture.  We discuss diagnosis, examination, and preliminary treatment options.  Part 2 will follow after the IFSSH meeting.  We also discuss upcoming, IFSSH- related episodes.

Some citations

1: Lieberdorfer A, Shivakumar N, Stonner MM, Brogan DM, Ray WZ, Mackinnon SE, Dy
CJ. Expectant Management, Tendon Transfer, or Nerve Transfer Surgery for Radial
Nerve Injury: A Qualitative Study Exploring Patient Expectations, Goals, and
Treatment Experiences. J Bone Joint Surg Am. 2023 Apr 19;105(8):600-606. doi:
10.2106/JBJS.22.01201. Epub 2023 Feb 16. PMID: 36795855.
 
2: Malikowski T, Micklesen PJ, Robinson LR. Prognostic values of
electrodiagnostic studies in traumatic radial neuropathy. Muscle Nerve. 2007
Sep;36(3):364-7. doi: 10.1002/mus.20848. PMID: 17587226.
 
3: Steenbeek ED, Pondaag W, Tannemaat MR, Van Zwet EW, Malessy MJA, Groen JL.
Optimal timing of needle electromyography to diagnose lesion severity in
traumatic radial nerve injury. Muscle Nerve. 2023 Apr;67(4):314-319. doi:
10.1002/mus.27787. Epub 2023 Jan 22. PMID: 36625338.

4.  PMID: 31714418
Radial Nerve Palsy Recovery With Fractures of the Humerus: An Updated Systematic Review.
Ilyas AM, Mangan JJ, Graham J.
J Am Acad Orthop Surg. 2020 Mar 15;28(6):e263-e269. doi: 10.5435/JAAOS-D-18-00142.


5. PMID: 32285189
Radial nerve palsy associated with closed humeral shaft fractures: a systematic review of 1758 patients.
Hendrickx LAM, Hilgersom NFJ, Alkaduhimi H, Doornberg JN, van den Bekerom MPJ.
Arch Orthop Trauma Surg. 2021 Apr;141(4):561-568. doi: 10.1007/s00402-020-03446-y. Epub 2020 Apr 13.

6.  PMID: 33335819
Incidence and Management of Radial Nerve Palsies in Humeral Shaft Fractures: A Systematic Review.
Hegeman EM, Polmear M, Scanaliato JP, Nesti L, Dunn JC.
Cureus. 2020 Nov 15;12(11):e11490. doi: 10.7759/cureus.11490.
PMID: 33335819 Free PMC article. Review.

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Transcript

Meeting summary for Radial Nerve Injury after humeral shaft fracture

Quick recap
     
Charles and Christopher discussed their experiences interviewing hand surgery fellowship candidates and mentioned the upcoming IFSSH meeting in Washington, DC. They then presented a case scenario involving the management of radial nerve palsy associated with a humeral shaft fracture, covering initial evaluation, conservative management, and potential surgical interventions. The discussion emphasized the importance of follow-up assessments, considering patient factors when choosing treatment options, and collaborating with hand therapists to set appropriate expectations.
 
Next steps
 
• Charles to prepare for recording promotional podcasts for the IFSSH annual meeting in Washington, DC at the end of March.
• Christopher to send Charles papers discussing nerve studies at 3-4 months and how they predict prognosis for radial nerve injuries.
• Charles and Christopher to record a follow-up episode specifically on nerve transfers for radial nerve palsy.
• Charles and Christopher to plan a sports-related episode after the nerve transfer episode.
• Listeners to email hand podcast@gmail.com  with suggestions for future sports topics.
   
  Summary
 
| Interview Experiences and Upcoming Meeting Plans
Charles and Christopher discussed their recent experiences with interviewing potential hand surgery fellows. Charles shared his positive experience with Peter Stern at Cincinnati, who met with numerous candidates over several months. Christopher mentioned that they welcomed 32 candidates to St. Louis for interviews, despite the challenges of limited capacity. They also discussed the upcoming annual meeting in Washington, DC, and the potential for future podcasts featuring guest hosts. The conversation ended with Charles presenting a case scenario for discussion.
 
Radial Nerve Palsy Management Strategies
The discussion covers the management of a radial nerve palsy associated with a humeral shaft fracture. Christopher and Charles discuss the initial evaluation, including physical exam techniques to assess radial nerve function. They recommend conservative management with a coaptation splint and wrist brace initially. Follow-up at 6 weeks is suggested, with consideration of nerve studies at that time or at 3 months. If no recovery is seen by 3-4 months, surgical intervention may be considered. Options include tendon transfers or nerve transfers, with pros and cons to each approach. The choice depends on patient factors like occupation and goals. Tendon transfers are described as reliable but with functional limitations. Nerve transfers can potentially provide better function but take longer to recover. The importance of collaborating with hand therapists and setting appropriate patient expectations is emphasized.