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Review Question - QID 6967

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QID 6967 (Type "6967" in App Search)
An 86-year-old woman sustained a fracture of the humerus and underwent surgical fixation 8 weeks ago. There was no radial nerve function below the elbow after surgery. Radiographs are shown in Figures 51a and 51b. What is the most appropriate management at this time?
  • A
  • B

Nerve conduction velocity studies and electromyography

29%

61/209

Exploration and grafting of the radial nerve

3%

7/209

Tendon transfers

1%

3/209

Observation for another 2 months

61%

127/209

Removal of the plate, neurolysis of the radial nerve, and intramedullary rodding of the humerus

3%

6/209

  • A
  • B

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Most radial nerve palsies associated with closed fractures of the humerus resolve spontaneously, including Holstein-Lewis lesions (radial nerve palsy associated with oblique distal third fractures of the humerus). Initial sign of recovery at the brachioradialis may not occur for 4 months. There has been no evidence of deleterious effects occurring during this observation period. There are advocates of early exploration of the nerve. Exploration in the intermediate period between 1 and 4 months is not supported. As overall alignment of the fracture is acceptable, there is no need for hardware exchange until nonunion is clearly identified.

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