Humerusschaftfrakturen mit primärer Radialisläsion: Revision des Nervs oder abwarten?

The incidence of lesions of the radial nerve associated with humerus shaft fractures varies in the literature between 1.8% and 20%. A revision of the nerve is discussed controversly. At present there are two accepted methods of treatment: - conservative therapy and waiting for spontaneous regression of the lesion of the nerve, - primary revision of the radial nerve. A primary paralysis of the radial nerve is an absolute indication for an operative therapy. We will establish this by the intraoperative findings of 48 patients of our department with surgical revisions of the radial nerve. Material, methods and results: At our former department (Department of traumatology, University of Munster), 174 patients with operatively treated humerus shaft fractures (1974-1990) were evaluated. The rate of primary paralysis of the radial nerve was 27% (n = 47). 39 of these patients were treatet by an surgical revision (31 primary revisions and 8 secondary revisions). Intraoperative we found five complete ruptures and two nerves interposed between fragments. In 17 cases the nerve was extremely contused, in 15 cases the nerve was macroscopically intact. At our department (Department of traumatology, University of Magdeburg) we treated 49 patients operatively between June 1995 and November 1997. The rate of nerval lesions of these patients was 18.4% (9 patients). Intraoperative we found one complete rupture of the nerve, eight extremely contused nerves. Conclusion: In consideration of our results from the departments of traumatology in Magdeburg and Munster we believe, that a humerus shaft fracture with paralysis of the radial nerve is an absolute indication for a surgical revision.