A 30-year-old man sustains a spiral fracture of the distal third of the humeral shaft. On examination he cannot extend the wrist or metacarpophalangeal joints but sensation over the dorsum of the hand is intact. Which statement about this injury is correct?
- A Observation is appropriate as most such palsies recover spontaneously within 3 to 4 months ✓
- B Immediate exploration of the nerve is mandatory
- C Sensory sparing indicates complete nerve transection
- D Tendon transfer should be performed at presentation
Correct answer: A. Observation is appropriate as most such palsies recover spontaneously within 3 to 4 months
Explanation
Radial nerve palsy associated with a Holstein-Lewis (distal third spiral) humeral shaft fracture is usually a neurapraxia or axonotmesis from traction rather than transection. Closed reduction with observation is accepted practice, since around 70 percent recover spontaneously by 3 to 4 months. Exploration is reserved for palsies appearing after manipulation, open fractures, or failure of recovery with absent EMG reinnervation by 3 to 4 months.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.