A patient with radial nerve palsy following a Holstein-Lewis fracture (middle-third/distal-third humeral shaft junction spiral fracture) is most likely to have which nerve involvement?

• A Radial nerve in the spiral groove of the humerus ✓
• B Posterior interosseous nerve (PIN) at the radial tunnel
• C Radial nerve at the anterior aspect of the lateral epicondyle
• D Superficial radial nerve at the wrist

Explanation

The Holstein-Lewis fracture is a spiral fracture at the junction of the middle and distal thirds of the humeral shaft. The radial nerve is tethered as it pierces the lateral intermuscular septum and enters the anterior compartment at this level (approximately 10 cm above the lateral epicondyle), making it susceptible to entrapment or traction injury in this fracture pattern. This is distinct from PIN palsy (at the radial tunnel, distal to the epicondyle) and from radial nerve injury in the spiral groove (mid-humerus fractures). Initial expectant management is often undertaken as many are neuropraxia/Grade II.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.