Radial nerve palsy following closed unreamed nailing of the humeral diaphysis: A case report

Background: Intramedullary nail gains increasing popularity as an option to treat fractures of the humeral shaft.The proximity of the radial nerve to the fracture site is always a concern for iatrogenic nerve damage during nailing.However, there is no documented report of direct radial nerve palsy due to nailing process.Case report: A forty-two years old man was involved in a road traffic accident and he sustained a close fracture of his left humeral diaphysis and a close fracture of the diaphysis of his ipsilateral tibia.Pre-operative examination did not reveal any neurovascular deficit.Due to the high energy of the injury, the patient was conduced to the operating Room where both fractures were stabilized with unreamed nailing.In the immediate post-operative period, he developed complete radial nerve palsy and it was urgently decided the remove of the nail.The radial nerve was found to be bruised but maintained its continuity.The humeral fracture was stabilized with plate fixation.Six months later, the radial nerve was, partially, recovered.A full motor and sensory recovery of the nerve was observed ten months later.Conclusion: Even if it's rare, there is a risk of damage of radial nerve during unreamed nailing of a fracture of the midshaft of the humerus.In these cases, the use of somatosensory; during the implantation of the nail, evoked potential monitoring, could offer us the opportunity to find the entrapment of radial nerve.