Recovery and functional outcome after radial nerve palsy in adults with a humeral shaft fracture: a multicenter prospective case series

Saskia H Van Bergen; Esther M M Van Lieshout; Michael H J Verhofstad; Dennis Den Hartog; HUMMER Investigators

doi:10.1016/j.jseint.2023.02.003

Recovery and functional outcome after radial nerve palsy in adults with a humeral shaft fracture: a multicenter prospective case series

JSES Int. 2023 Feb 23;7(3):516-522. doi: 10.1016/j.jseint.2023.02.003. eCollection 2023 May.

Authors

Saskia H Van Bergen¹, Esther M M Van Lieshout¹, Michael H J Verhofstad¹, Dennis Den Hartog¹; HUMMER Investigators

Collaborators

HUMMER Investigators:
Ivo Beetz¹, Hugo W Bolhuis², P Koen Bos³, Maarten Wga Bronkhorst⁴, Milko Mm Bruijninckx⁵, Jeroen De Haan⁶, Axel R Deenik⁷, P Ted Den Hoed⁸, Martin G Eversdijk⁹, J Carel Goslings¹⁰, Robert Haverlag¹¹, Martin J Heetveld¹², Albertus Jh Kerver¹³, Karel A Kolkman¹⁴, Peter A Leenhouts¹⁵, Kiran C Mahabier¹, Sven Ag Meylaerts⁴, Ron Onstenk¹⁶, Martijn Poeze¹⁷, Rudolf W Poolman¹⁸, Bas J Punt¹⁹, Ewan D Ritchie²⁰, W Herbert Roerdink²¹, Gert R Roukema²², Jan Bernard Sintenie²³, Nicolaj Mr Soesman²⁴, Edgar Jt Ten Holder²⁵, Wim E Tuinebreijer¹, Maarten Van der Elst²⁶, Frank Hwm Van der Heijden²⁷, Frits M Van der Linden²⁸, Peer Van der Zwaal⁴, Jan P Van Dijk²⁹, Hans-Peter W Van Jonbergen³⁰, Egbert Jmm Verleisdonk³¹, Jos Pam Vroemen³², Marco Waleboer³³, Philippe Wittich³⁴, Wietse P Zuidema³⁵

Affiliations

¹ Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
² Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands.
³ Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁴ Trauma Unit, Haaglanden MC, The Hague, The Netherlands.
⁵ Department of Surgery, IJsselland Hospital, Capelle a/d Ijssel, The Netherlands.
⁶ Department of Surgery, Dijklander Ziekenhuis, Hoorn, The Netherlands.
⁷ Department of Orthopaedic Surgery, Haaglanden MC, The Hague, The Netherlands.
⁸ Department of Surgery, Ikazia Hospital, Rotterdam, The Netherlands.
⁹ Department of Surgery, St. Jansdal Hospital, Harderwijk, The Netherlands.
¹⁰ Trauma Unit, Department of Surgery, Amsterdam University Medical Center, location AMC, Amsterdam, The Netherlands.
¹¹ Department of Surgery, OLVG, Amsterdam, The Netherlands.
¹² Department of Surgery, Spaarne Gasthuis, Haarlem, The Netherlands.
¹³ Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
¹⁴ Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
¹⁵ Department of Surgery, Zaans Medical Center, Zaandam, The Netherlands.
¹⁶ Department of Orthopaedic Surgery, Groene Hart Hospital, Gouda, The Netherlands.
¹⁷ Department of Trauma Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁸ Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands.
¹⁹ Department of Surgery, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
²⁰ Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.
²¹ Department of Surgery, Deventer Hospital, Deventer, The Netherlands.
²² Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
²³ Department of Surgery, Elkerliek Hospital, Helmond, The Netherlands.
²⁴ Department of Surgery, Franciscus Gasthuis & Vlietland, Schiedam, The Netherlands.
²⁵ Department of Orthopaedic Surgery, IJsselland Hospital, Capelle a/d IJssel, The Netherlands.
²⁶ Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands.
²⁷ Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
²⁸ Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.
²⁹ Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.
³⁰ Department of Orthopaedic Surgery, Deventer Hospital, Deventer, The Netherlands.
³¹ Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands.
³² Department of Surgery, Amphia Hospital, Breda, The Netherlands.
³³ Department of Surgery, Admiraal De Ruyter Hospital, Goes, The Netherlands.
³⁴ Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
³⁵ Department of Trauma Surgery, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands.

Abstract

Background: The consequences of radial nerve palsy associated with a humeral shaft fracture are unclear. The aim of this study was to examine the functional recovery of radial nerve palsy, at presentation or postoperatively, in patients with a humeral shaft fracture.

Methods: Data from patients who participated in the HUMeral shaft fractures: measuring recovery after operative versus non-operative treatment (HUMMER) study, a multicenter prospective cohort study including adults with a closed humeral shaft fracture Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 12A or 12B, and had radial nerve palsy at presentation or postoperatively, were extracted from the HUMMER database. The primary outcome measure was clinically assessed recovery of motor function of the radial nerve. Secondary outcomes consisted of treatment, functional outcome (Disabilities of the Arm, Shoulder, and Hand and Constant-Murley Score), pain level, quality of life (Short Form-36 and EuroQoL-5D-3L), activity resumption, and range of motion of the shoulder and elbow joint at 12 months after trauma.

Results: Three of the 145 nonoperatively treated patients had radial nerve palsy at presentation. One recovered spontaneously and 1 after osteosynthesis. Despite multiple surgical interventions, the third patient had no recovery after entrapment between fracture fragments. Thirteen of the 245 operatively treated patients had radial nerve palsy at presentation; all recovered. Nine other patients had postoperative radial nerve palsy; 8 recovered. One had ongoing recovery at the last follow-up, after nerve release and suture repair due to entrapment under the plate. At 12 months, the functional outcome scores of all patients suggested full recovery regarding functional outcome, pain, quality of life, activity resumption, and range of motion.

Conclusion: Radial nerve palsy in patients with a humeral shaft fracture at presentation or postoperatively functionally recovers in 94% and 89%, respectively.

Keywords: Fracture; Humerus; Nonoperative; Operative; Radial nerve palsy; Shaft.