Surgical management and outcome in patients with radial nerve lesions

Object. The goal of this paper was to review surgical management and outcom es in patients treated for radial nerve (RN) lesions at Louisiana State Uni versity Health Sciences over a period of 30 years. Methods. Two hundred sixty patients with RN injuries were evaluated. The mo st common mechanisms of injuries involving the RN included fracture of the humerus, laceration, blunt contusions, and gunshot wounds. One hundred and eighty patients (69%) underwent surgery. Lesions not in continuity required primary or secondary end-to-end suture repairs or graft repairs. With the use of direct intraoperative nerve action potential recording, RN injuries in which the lesion was in continuity required external or internal neuroly sis or resection of the lesion followed by end-to-end suture or graft repai r. A minimum of 1.5 years follow-up review was available in 90% of the pati ents who underwent surgery. Motor function recovery to Grade 3 or better wa s observed in 10 (91%) of 11 patients who underwent primary suture repair, 25 (83%) of 30 who underwent secondary suture repair, 43 (80%) of 54 who re ceived graft repair, and 63 (98%) of 64 in whom neurolysis was performed. S ixteen (71%) of 21 patients with superficial sensory RN injury achieved sat isfactory pain relief after complete resection of a neuroma or neurolysis. Conclusions. This study clearly demonstrates that excellent functional reco very can be achieved with proper surgical management of RN injuries.