[Traumatic lesions of the radial nerve of the arm]

Abstract

The authors analyse their experience with 63 lesions of the radial nerve in the upper arm. 39 cases were associated with fractures of the humeral shaft, 20 cases with open wounds or nerve contusions, and 4 cases with grade 3 complicated humeral fractures with neurovascular lesions. In contusions and open wounds the indication for nerve reconstruction is obvious and results are good or very good after graft-reconstruction or suture. In closed humeral fractures, the results of nerve reconstructions and the improvement of microsurgical techniques, together with precise indications are in favor of treatment of radial nerve lesions by suture or graft-reconstruction. Muscular transfers are only secondary procedures to the nerve reconstruction itself. The indications for treatment in emergency of fractures of the humeral shaft associated with radial nerve palsy, depend on the type of fracture, the associated lesions and the cutaneous status. An osteosynthesis is desirable in specific situations, like in poly-traumatised patients or multiple-level fractures of the upper limb, and an exploration of the radial nerve will be done during exposure. We believe also that an osteosynthesis with exploration of the radial nerve is indicated in severely displaced fractures, in particular in oblique or spiral midshaft fractures, and in fractures of the distal third of the humerus, because in this type of fracture a majority of radial nerve lesions, accessible to direct suture are found. In all the other cases, conservative treatment remains indicated with clinical and electromyographical follow-up and exploration two months after fracture union, in the rare cases of absence of recovery.