The Holstein-Lewis Humeral Shaft Fracture: Aspects of Radial Nerve Injury, Primary Treatment, and Outcome

Objective: The primary aim was to describe the epidemiology of the Holstein-Lewis humeral shaft fracture, its association with radial nerve palsy, and the outcome regarding recovery from the radial nerve palsy and fracture healing. The secondary aim was to analyze the long-term functional outcome. Setting: Six major hospitals in Stockholm County. Design: Descriptive. study. Retrospective assessment of radial nerve recovery and fracture healing. Prospective assessment of functional outcome. Patients: Twenty-seven patients with a 12A1.3 humeral shaft fracture according to the OTA classification satisfying the criteria of a Holstein-Lewis fracture in a population of 358 patients with 361 traumatic humeral shaft fractures. Intervention: Nonoperative or operative treatment according to the decision of the attending orthopaedic surgeon. Main Outcome Measurements: Recovery of the radial nerve, fracture healing, and functional outcome according to the Short Musculoskeletal Function Assessment (SMFA). Results: The Holstein-Lewis humeral shaft fracture constitutes 7.5% of all humeral shaft fractures and was associated with an increased risk of acute radial nerve palsy compared with other types of humeral shaft fractures, 22% versus 8% (P < 0.05). The fractures of 6 of the 7 operatively treated patients healed after the primary surgical procedure while I fracture healed after revision surgery. The fractures of all patients treated nonoperatively healed without any further intervention. All 6 radial nerve palsies (2 patients treated nonoperatively and 4 operatively) recovered. The functional outcome according to the SMFA was good with no differences between the nonoperatively and operatively treated patients: SMFA dysfunction index 7.6 and 9.7, respectively, and SMFA bother index 6.1 and 6.8, respectively. Conclusions: The Holstein-Lewis humeral shaft fracture was associated with a significantly increased risk of acute radial nerve palsy. The overall outcome regarding fracture healing, radial nerve recovery, and function was very good regardless of the primary treatment modality, that is, operative or nonoperative treatment. The indication for primary operative intervention in this fracture type appears to be relative.