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Radial Nerve Recovery After Humerus Fracture Using Frequentist and Bayesian Statistics
Nienke A. Krijnen, Alexander Comerci, Linden K. Head, Ingmar W. F. Legerstee, Huub H. de Klerk, Neal Chen, Teun Teunis
University of Pittsburgh Medical Center
2025-01-10
Presenter: Nienke Krijnen
Affidavit:
Yes
Director Name: Vu Nguyen
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: Humerus fractures are among the most common fractures and are accompanied by radial nerve injury in approximately 1 in 8 patients. Since most radial nerve injuries are likely to recover spontaneously, the optimal timing of surgery is unclear.
Methods: We retrospectively re-screened records from a previously established patient cohort of 577 adults with surgically treated humerus fractures for patients with a radial nerve palsy (n=53). The median age was 43 years (range 18 to 94), and 49% were male. Most palsies were present preoperatively (83%) and median time from injury to surgery was 2 days (range 0 to 64). We collected data on motor recovery (Medical Research Council 3) of the wrist and digits.
Results: Although the Kaplan-Meier function shows that after 4 months more than 50% of patients recovered wrist and/or digits extension, the probability that a patient is going to recover, assessed with Bayesian statistics, remains above 50% up to 7 months. If a patient has not yet recovered, the probability that a patient is going to recover is 46% at 8 months, 30% at 10 months, and 17% at 12 months.
Conclusions: Early exploration or nerve transfers for radial nerve injury after humerus fractures seem to carry a significant risk of overtreatment, as patients still have a substantial chance of spontaneous recovery at that time. Awaiting recovery for at least one year and performing tendon transfers seems to result in the lowest amount of overtreatment and unnecessary iatrogenic harm.
