Maine Orthopaedic Review Challenge

Test Your Knowledge of Treating Fractures in Trauma Patients

Bruce F. Gomberg, MD; Brad J. Yoo, MD


August 24, 2017

Most radial nerve palsies associated with closed fractures of the humerus, including Holstein-Lewis lesions (radial nerve palsy associated with oblique distal third fractures of the humerus), resolve spontaneously. In patients with radial nerve injuries with closed humeral fractures, it has been reported that 85%-95% spontaneously recover.[4] Clinical signs of recovery at the brachioradialis may not occur for 4 months. Exploration in the intermediate period between 1 and 4 months is not supported.

The fracture is anatomically reduced, so urgent open reduction and internal fixation is not necessary and the fracture may be treated closed with a fracture brace. If there are no clinical or EMG signs of recovery at 6 months, exploration is recommended. If the nerve is in continuity at the time of exploration, nerve action potentials are useful in helping determine the need for neurolysis, excision, and grafting, or whether excision and repair is the best option.[4]


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