Systematic review of 35 studies (1045 patients) pooling 40 years of evidence on radial nerve palsy after humeral shaft fracture. The central question: does early surgical exploration produce better nerve recovery than watchful waiting?
When you see a closed humeral shaft fracture with radial nerve palsy at presentation, initial expectant management is appropriate — over 70% will recover spontaneously and early exploration offers no outcome advantage.
Set a calculated waiting deadline (≤6 months based on fracture-to-brachioradialis distance at 1 mm/day) and arrange serial EMG/NCV; reserve exploration for failure to improve within that window.
Systematic review of 35 studies (1045 patients) pooling 40 years of evidence on radial nerve palsy after humeral shaft fracture. The central question: does early surgical exploration produce better nerve recovery than watchful waiting?
When you see a closed humeral shaft fracture with radial nerve palsy at presentation, initial expectant management is appropriate — over 70% will recover spontaneously and early exploration offers no outcome advantage.
Set a calculated waiting deadline (≤6 months based on fracture-to-brachioradialis distance at 1 mm/day) and arrange serial EMG/NCV; reserve exploration for failure to improve within that window.