Postoperative radial nerve paralysis caused by fracture callus

Area of Science:

• Orthopedic Surgery
• Neurology
• Trauma Care

Background:

• Open reduction and internal fixation (ORIF) is a standard procedure for comminuted distal humerus fractures.
• Radial nerve injury is a known complication, but typically presents intraoperatively or early postoperatively.
• Late-onset complications require careful consideration of surgical technique and healing processes.

Observation:

• A case of delayed radial nerve paralysis is presented, occurring 6 weeks post-ORIF.
• Reoperation revealed a transected radial nerve embedded within developing bone callus.
• The presumed mechanism involved repetitive nerve friction against a sharp bony edge.

Findings:

• The radial nerve was transected within the callus formation, leading to paralysis.
• Surgical repair and subsequent tendon transfers did not achieve full functional recovery at 16 months.
• This represents a unique presentation of iatrogenic radial nerve injury post-humerus fracture fixation.

Implications:

• Highlights the potential for delayed nerve injury due to bone healing dynamics after fracture fixation.
• Suggests careful monitoring for neurological deficits weeks after surgery, even without initial signs.
• Underscores the importance of meticulous surgical technique to minimize nerve irritation during bone healing.