Review of literature of radial nerve injuries associated with humeral fractures-an integrated management strategy

YuLin Li, GuangZhi Ning, Qiang Wu, QiuLi Wu, Yan Li, ShiQing Feng, YuLin Li, GuangZhi Ning, Qiang Wu, QiuLi Wu, Yan Li, ShiQing Feng

Abstract

Background: Radial nerve palsy associated with fractures of the shaft of the humerus is the most common nerve lesion complicating fractures of long bones. However, the management of radial nerve injuries associated with humeral fractures is debatable. There was no consensus between observation and early exploration.

Methods and findings: The PubMed, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, CINAHL, International Bibliography of the Social Sciences, and Social Sciences Citation Index were searched. Two authors independently searched for relevant studies in any language from 1966 to Jan 2013. Thirty studies with 2952 humeral fractures participants were identified. Thirteen studies favored conservative strategy. No significant difference between early exploration and no exploration groups (OR, 1.03, 95% CI 0.61, 1.72; I(2) = 0.0%, p = 0.918 n.s.). Three studies recommend early radial nerve exploration in patients with open fractures of humerus with radial nerve injury. Five studies proposed early exploration was performed in high-energy humeral shaft fractures with radial nerve injury.

Conclusions: The conservative strategy was a good choice for patients with low-energy closed fractures of humerus with radial nerve injury. We recommend early radial nerve exploration (within the first 2 weeks) in patients with open fractures or high-energy closed fractures of humerus with radial nerve injury.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flowchart of trials selection process.
Figure 1. Flowchart of trials selection process.
Figure 2. Forest plots of pooling nerve…
Figure 2. Forest plots of pooling nerve functional recovery between early exploration groups and no exploration groups.
Figure 3. Forest plots of pooling nerve…
Figure 3. Forest plots of pooling nerve functional recovery between delay exploration groups and no exploration groups.
Figure 4. Management strategy of radial nerve…
Figure 4. Management strategy of radial nerve injuries associated with humeral fractures (US: ultrasonography; EMG: electromyogram; NAP: nerve axonal physiology; NCV: nerve conduction velocity).

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