A Rare Finding of Radial Nerve Transection Associated with a Closed Humeral Shaft Fracture

Nova Southeastern University, Davie, Florida, USA

Introduction: A common complication seen with humeral shaft fractures is radial nerve palsy. A lack of consensus remains regarding the management of radial nerve dysfunction secondary to humeral shaft fractures, specifically with closed fractures. An increasing number of reports suggest that nonsurgical treatment leads to recovery of nerve function in nearly all patients. Case Presentation: 25-year-old female who was involved in a pedestrian vs motor vehicle accident. A passing vehicle swiped her right side, causing multiple injuries to her right upper extremity. She was brought to Broward Medical Center as a level 1 adult trauma. Examination revealed obvious deformities of the right upper extremity. On neurological exam the posterior interosseous nerve motor function was absent and her sensation to light touch over the radial nerve distribution was decreased. Radiographs revealed a right closed segmental midshaft humerus fracture. Exploration revealed that the radial nerve was found to be transected and within the fracture site. Open reduction and internal fixation of the midshaft humerus was achieved. Plastic surgery was urgently consulted for neurorrhaphy of the radial nerve. The patient tolerated the procedure well and is being followed postoperatively. Discussion: This case is unique in that the radial nerve was transected in relation to a closed humeral shaft fracture. Transections found after closed humeral shaft fractures are extremely rare. Most radial nerve transections are commonly reported in the presence of an open humeral shaft fracture. With primary exploration, we prevented unnecessary delay that may have otherwise blunted the healing ability of the radial nerve. This case highlights the importance of clinical judgment.