[Postoperative radial paralysis. Fate or negligence, conservative wait or revision?]

Radial nerve palsy is a rather frequent complication caused by an accident as well as by surgery of the humerus. As a primary, i.e., accidental lesion, its incidence as stated in the literature is up to 30%, primarily fractures in the distal diaphyseal half. Secondary, i.e., surgically induced, nerve lesions surprisingly are reported with a similar frequency, though recently the incidence only approaches some 3%. Experts continue to argue over the timing for operative revision. Many authors rely on spontaneous recovery of the nerve as maintained by L. Boehler in the early 1960s, but this theory was rendered obsolete by the technical achievements of microsurgery and the patients' economic constraints. Other authors are afraid of accidentally damaging the nerve by revision surgery. The stand we take in this controversy is instant revision surgery both for accidental lesions as well as uncompromisingly for those incurred during surgery when the surgeon had not explored the nerve far enough to preserve it during the operation. Three exemplary cases are reported, one of them submitted for an expert's opinion because of an alleged mistake on the part of the doctor. Forensic responsibility has to match actual indication principles and the specific technique applied.