Atypical injury of radial nerve after humeral shaft fracture

As general opinion, conservative treatment is usually suggested for closed humeral shaft fractures with radial nerve palsy; however, some authors advocate early surgical exploration, particularly for spiral fractures of the humerus accompanied with radial nerve palsy. In this article, we present a case of radial nerve palsy after fracture of the proximal-middle third of humeral shaft. A surgical exploration of the nerve revealed that the sharp tip of the bony fragment at fracture site was penetrated into the nerve and separated the nerve as two bands, almost like a "buttonhole" injury. We think that this kind of an atypical injury of the radial nerve would most probably not recover with conservative management; or the nerve may even be damaged worse by the fragment in case of a possible movement on the nerve's fracture line or by being trapped by callus formation during healing. In this case report, we aimed to raise awareness among orthopedists regarding such and similar atypical injuries of the radial nerve.