Should surgeons operate on a radial nerve not improving 2 months after humerus fracture?
Steve K. Lee, MD, chief of the hand and upper extremity service at HSS provides insight on if surgeons should operate on a radial nerve not improving 2 months after humerus fracture.
“I believe this answer is much different today compared to 10 to 15 years ago. When I see a patient with radial nerve palsy after humerus fracture, I get advanced imaging of MR neurography and ultrasound to determine if the radial nerve is injured and if there is fascicular continuity throughout the zone of injury. I am also looking to see if there is any neuroma formation. Other questions I ask the radiologist is whether there is external compression on the nerve, impingement from bone fragments, scar tether, compression from hematoma or other findings. There is more suspicion for operative nerve injury if the fracture is open and if the palsy occurred after manipulation. I also use the advanced imaging gunshot wounds. High resolution imaging can show if the bullet or projectile fragments have made the nerve partially or fully discontinuous,” explained Dr. Lee.
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