RADIAL NERVE PALSY ASSOCIATED WITH FRACTURES OF THE SHAFT OF THE HUMERUS: A SYSTEMATIC REVIEW

Background: Radial nerve palsy is the most common peripheral nerve injury complicating fractures of the humeral shaft. Itsoptimal management — early surgical exploration versus initial expectant observation — has remained contentious fordecades. We systematically reviewed the published evidence to define the prevalence of radial nerve palsy, its relationship tofracture pattern and location, and the rates of nerve recovery following the principal management strategies. Materials andMethods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews andMeta-Analyses (PRISMA) 2020 statement. PubMed/MEDLINE, Embase, the Cochrane Library and Google Scholar weresearched from inception to April 2026 for studies reporting radial nerve palsy associated with humeral shaft fractures. Tworeviewers independently screened records, extracted data and appraised methodological quality. Pooled proportions werederived for prevalence, association with fracture morphology and rates of nerve recovery under expectant and operativemanagement. Results: The pooled prevalence of radial nerve palsy across humeral shaft fractures was approximately 12%(range 8–16%), rising to about 22% for distal-third spiral (Holstein–Lewis) fractures. Transverse and spiral configurations andmid-shaft or middle–distal-third locations carried the highest risk (p < 0.001). Overall nerve recovery exceeded 88%, andspontaneous recovery occurred in roughly 71% of palsies managed expectantly. There was no significant difference in finalrecovery between fractures initially observed and those explored early. Secondary (iatrogenic) palsy complicatedapproximately 3–6% of operatively treated fractures. A minority of patients with confirmed nerve transection or entrapment,or with no clinical or electrophysiological recovery by 3–4 months, benefited from delayed exploration and reconstruction.Conclusion: The great majority of radial nerve palsies associated with closed humeral shaft fractures are neurapraxic oraxonotmetic and recover spontaneously. Initial expectant management with a structured programme of clinical andelectrophysiological surveillance is supported as the default strategy for closed injuries, reserving exploration for openfractures, fractures requiring operative fixation, palsy developing after reduction, and injuries showing no recovery within 3–4 months