Radial nerve palsy following pediatric humeral shaft fractures: a systematic review and pooled analysis.

Abstract

Pediatric humeral shaft fractures associated with radial nerve palsy are rare, with an incidence of 4-4.35%. There exists one study on this topic; this systematic review and pooled analysis aim to shift the focus from incidence to recovery, apply patient-level analyses, reassess previously reported associations, identify discrepancies to inform clinical decision-making, and elucidate possible factors associated with poor recovery using exploratory and hypothesis-generating analyses. PubMed, Cochrane Central, and Google Scholar were searched using the following terms: (radial nerve palsy) AND (humerus fracture) AND (pediatrics OR children). Inclusion criteria included case reports, retrospective or systematic reviews, patients aged 1-18 years, and humeral shaft fractures with radial nerve palsy. Exclusion criteria included non-English studies. This yielded 13 studies; 11 provided sufficient data for analysis (32 patients). Oblique fractures were observed more frequently with delayed recovery (>4 months) or no recovery (P = 0.040). Neurotmesis and fibrosis surrounding the nerve were observed with delayed recovery (P = 0.002). Closed reduction and fixation were associated with worse nerve outcomes than conservative treatment (P = 0.013). Patients undergoing nerve procedures were frequently observed with impaired nerve recovery (P = 0.017). However, when evaluating for ordinal differences in recovery, there was no significant difference (Kruskal-Wallis H test P = 0.282). This review found that, unlike adults, distal and oblique humeral shaft fractures in children are associated more frequently with poorer outcomes of radial nerve injury. Clinicians may consider careful, early assessment of the radial nerve in displaced, distal, oblique humeral fractures.