Intraoperative interfragmentary radial nerve compression in a medially plated humeral shaft fracture: a case report

Persistent secondary radial nerve palsy following open reduction and plating of humeral shaft fractures is rare, as the nerve is usually identified and protected throughout surgery. However, it is very difficult to identify and protect the radial nerve during medial and posteromedial approaches and closed intramedullary nailing, thus increasing the risk of damaging it. This case of interfragmentary radial nerve compression at the fracture site occurred during posteromedial plating of a laterally displaced and angulated segmental fracture of the middle and distal thirds of the humeral shaft. Exploration and nerve grafting was later required to regain function. It is important that the radial nerve be identified and protected in fixation of humeral shaft fractures with high-risk fracture configurations.