Shaft of Humerus fracture with Radial Nerve Palsy

 How do you approach a patient with shaft of himerus fracture with radial nerve palsy?

    Approach based on ATLS. 

    Exclude other injuries - NV, Open wounds, compartment syndrome 

    AMPLE History

    Analgesia

    Splinting 

    Collar and Cuff with gravity traction

    Fracture can be managed non-operative or operatively based on fracture displacement and fracture             geometry 


https://nerveclinic.co.uk/nerve-injuries/nerve-injury-after-fracture-or-dislocation

    Early Immediate Exploration Criteria for Radial Nerve Injury

    (https://www.aofoundation.org/trauma/about-aotrauma/blog/2023_03-      blog-moharram-lambert-radial-nerve-palsy)

    Open Fractures with Radial Nerve Palsy 

     High velocity injuries - Gunshot wounds, Penetrating wounds, Severe soft tissue damage

    Neurotemesis (complete transection ) signalled by loss of Brachioradialis function, finger and wrist        drop

    There is no need of exploring the nerve nerve while fixing the humerus if there are no indications. 

     Otherwise we manage the  Radial Nerve expectantly. 

    90 % - Neuropraxia and recover within 3-4 months.

    Wrist splint( in extension ) for wrist drop 

    Physiotherapy - to maintain range of motion. 

If radial nerve palsy does not improve after 4 months, what will you do ?

    Nerve conduction , EMG studies.

    If neuroproaxia - continue to monitor expectantly.

    If muscle denervated, action potential - Fibrillation potential on EMGs.

    Refer to local peripheral nerve injury specialist.

 Principles of tendon transfer 

    1. Supple joint with full ROM

    2. Donor should be healthy and expendable.

        Grade 5 , MRC Power

        Adequate Excursion    

        Synergist

        Straight line of pull

   3. Recipient - tendon of paralyzed muscle 

    4. Common transfer 

        ECRB to supplement by Pronator Teres 

        Palmaris longus (PL) by EPL

        Flexor Carpi Radialis (FCR) by ED 



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