From the Research
For repairing a radial nerve injury caused by a humerus shaft fracture, I recommend using 8-0 or 9-0 monofilament nylon sutures for epineural repair, as this approach has been shown to result in favorable outcomes in terms of morbidity, mortality, and quality of life 1. The repair should be performed under microscopic magnification using tension-free technique with minimal handling of the nerve ends. The procedure involves:
- Careful debridement of damaged nerve tissue
- Alignment of the nerve fascicles
- Placement of 6-8 epineural sutures circumferentially around the nerve If there is a gap between nerve ends that prevents tension-free repair, consider using a nerve graft (typically harvested from the sural nerve) 2. The timing of the repair is crucial, and it is recommended to perform the repair as soon as possible after injury, ideally within the first 3-6 months, as delayed repair can still be beneficial but may result in poorer outcomes 1, 3. Following repair, the arm should be immobilized for 3-4 weeks to prevent tension on the repair site. The choice of monofilament nylon is based on its minimal tissue reactivity, adequate tensile strength, and ease of handling. Recovery after radial nerve repair is typically slow, with motor function potentially taking 12-18 months to return, and patients should be counseled about this timeframe and the need for physical therapy to maintain joint mobility during recovery 1. It is essential to note that the energy of trauma may be a factor predicting patient's final recovery following the treatment, and expectant management followed by surgery of radial nerve injury associated with humeral shaft fracture should be around 3 months, and the surgical nerve repair should not be performed later than the 6 months after injury 1.