Surgical Management of Traumatic Radial Nerve Injury

Background: Traumatic peripheral nerve injury (PNI) is a serious medical condition encountered in many of the injuries to the upper and lower extremities, and in 3-10% of patients. The average incidence of radial nerve lesions is approximately 11%. Wrist drop represents the most common presentation of radial nerve palsy. Radial nerve palsy after fracture of the humerus is the most common nerve lesion in long bone fractures. This palsy may occur acutely at the time of injury, secondary to fracture manipulation, or from healing callus. Radial nerve may be injured at axilla by direct pressure. The surgical treatment of PNIs is still a challenging and highly demanding procedure. An understanding of the pathophysiology of PNI and selection of a suitable time for surgery are necessary for proper treatment of this challenging disorder although some nerve injuries recover spontaneously, in some cases surgery is the only therapeutic option for the improvement of neurological deficits or control of neuropathic pain. Objectives: To review the cases of radial nerve injury, to highlight the etiological factors leading to radial nerve injury resulting in wrist drop, evaluate the result of primary and delayed peripheral nerve repair after various types of injury and determine factors favoring good prognosis. Patients and Methods: This is a retrospective study of twenty patients of traumatic radial nerve injury which were managed in our department. All their clinical data, electromyogram (EMG) and nerve conductive study (NCS), the indication of surgery, its timing and type of surgery and outcome were collected to assess the surgical role. Results: Success was seen in seven out of eight patients who underwent primary repair and in six patients who underwent delayed repair. Excellent results were common in younger patients. Conclusion: In addition to the clinical examination, the nerve conduction studies and electromyography is a useful investigation tool to assess the injury, and to monitor the recovery following the primary repair. In order to achieve good results, it is important to follow the rules required for proper surgical repair of peripheral nerves.