Science News: Time to Recovery of Radial Nerve Palsy After Surgically Treated Humeral Shaft Fractures

Edited by: Rebecca O'Bryan, MD

Citation: Gomez C, Perez A, Breyer JM, Vergara P. Time to Recovery of Radial Nerve Palsy After Surgically Treated Humeral Shaft Fractures. J Hand Surg Am. 2025;50(9):1081-1087. doi:10.1016/j.jhsa.2024.11.024

Summary: This study evaluated neurologic recovery of complete radial nerve palsy in patients with humeral shaft fractures treated with internal fixation. This was a retrospective study of patients with complete sensory and motor radial nerve palsy. Time elapsed until detection of the first clinical signs of neurologic recovery and then until full function was measured. 32 patients with radial nerve palsy were identified out of 471 treated with humeral fractures. 30 recovered full motor function at a median time of 36 weeks. 90.6% showed first clinical signs of neurologic recovery within 6 months. At 12 and 18 months follow up 84% and 94% of patients respectively had recovered full wrist and hand function. Conclusions were that nearly all patents with radial nerve palsy due to humeral shaft fracture that are treated with ORIF will recover full neurological function within 12 months, and the first signs of recovery are expected prior to 6 months post op.

Comments: Radial nerve palsy has an incidence of 2-17% of cases of humeral shaft fracture. This can be due to the fracture itself or the ORIF to repair the injury, and can be mild or severe. Nonsurgical management has been favored due to the observation of spontaneous recovery in most patients without surgical intervention. However, this is controversial, and the timeframe to intervene with surgery is also up for debate. This study aims to provide a timeline for moving forward with surgical intervention. Electrodiagnostic study within 6 months would be beneficial in these cases with delayed recovery to ensure early identification of in continuity in need of surgical repair.

Why is this article interesting/relevant to the AANEM audience? The majority of patients with radial nerve palsy due to humeral shaft fracture have an excellent prognosis. However, identification of the subgroup of patients who do not recover and are in need of early surgical reconstruction is very important. This study provides some guidance for our role as electrodiagnostic specialists to ensure that those patients who are not showing signs of neurologic recovery within the first 6 months should be evaluated in the case of in continuity in need of surgical intervention.