Evidence Favours Observation, But Practice Promotes Exploration: Spontaneous Recovery of Radial Nerve Palsy After Minimally Invasive Plating of a Closed Humeral Shaft Fracture

Gupta PK* and Kumar R
 

Department of Orthopaedics, ISIC Multispecialty hospital, Vasant Kunj, New Delhi, India

^*Correspondance to: Pratyaksh Kumar Gupta 

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Abstract:

Radial nerve palsy is the most common peripheral nerve injury associated with the fractures of the humeral shaft. Most published studies, including systematic reviews and a decision analysis, show that primary palsy after a closed humeral shaft fracture recovers spontaneously in the great majority of patients and that early exploration of the nerve does not improve the outcome, even when the fracture is fixed surgically. In India, however, many orthopaedic surgeons still recommend exploring the radial nerve, and in our experience, this recommendation is driven more by the fear of litigation than by scientific evidence. We report the case of a 42-year-old man who sustained a closed, displaced transverse fracture of the left humeral shaft with a small butterfly fragment (AO/OTA 12B3) following a road traffic accident. He presented with complete wrist and finger drop and reduced sensation over the first dorsal web space. After the deficit had been documented, the fracture was fixed two days after the injury with a 12-hole locking compression plate using an anterior minimally invasive plate osteosynthesis technique. The radial nerve was not explored at the fracture site. Eight weeks and five days after surgery, the patient had regained full active wrist extension. We review the published evidence and contrast it with the recommendations of Indian surgeons and the medicolegal climate in which they work. We argue that in closed injuries without specific indications, the nerve injury need not be surgical surgically explored. Careful documentation, clear communication, informed consent, and structured follow-up are the real safeguards for patient and surgeon.

Keywords:

Radial nerve palsy; Humeral shaft fracture; Nerve exploration; Minimally invasive plate osteosynthesis; Neurapraxia; Medicolegal; Defensive medicine

Cite the Article:

Gupta PK, Kumar R. Evidence Favours  Observation, But Practice Promotes Exploration: Spontaneous Recovery of Radial Nerve Palsy After Minimally Invasive Plating of a Closed Humeral Shaft Fracture. Clin Case Rep Int. 2026; 10: 1793..