Radial nerve injuries in unrecovered radial nerve palsy associated with humerus fractures

Objectives: The therapeutic management of radial nerve palsy secondary to humerus fractures presents a complex clinical scenario with diverse presentations and treatment approaches. However, there is limited understanding of the specific patterns of unrecovered radial nerve injuries in this context. This study sought to investigate and characterize the spectrum of radial nerve injuries associated with humerus fractures, particularly focusing on cases with persistent palsy. Methods: A retrospective analysis was conducted on 20 patients with persistent radial nerve palsy following humerus fractures, who underwent radial nerve exploration and subsequent wrist drop tendon transfers between 2017 and 2023. Functional outcomes were assessed using Jerome’s scoring system. Results: The study identified four distinct types of radial nerve injury: Nerve entrapment within the fracture ( n = 6), nerve gap ( n = 6), nerve crush injury with minimal continuity ( n = 5), and nerve adhesions with the plate ( n = 3). All patients underwent tendon transfers to address wrist drops. Of these, 16 patients (80%) achieved favorable outcomes, while three exhibited fair outcomes, and one had a poor outcome. Conclusion: Untreated radial nerve palsy associated with humerus shaft fractures and definitive radial nerve injury presents a complex clinical scenario, necessitating further investigation and management strategies.