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What is the probability of radial nerve recovery after operated humerus fractures accounting for time since injury?
Elou Kingma
1,Nienke A. Krijnen
1, Alexander Comerci
1, Linden Head
2, Ingmar Legerstee
3, Huub H. de Klerk
3, Neal Chen
3, Teun Teunis
1
1Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States. 2Division of Plastic Surgery, Queen's University, Kingston, ON, Canada. 3Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, United States.
Background: Radial nerve neuropathy after operative treatment of humeral shaft fracture usually improves when the nerve is in continuity, but a subgroup of patients does not recover. Retrospective studies using Frequentist statistical analysis do not effectively incorporate time from injury as a predictive factor, but Bayesian analysis allows for better handling of this variable. Using Bayesian methods applied to a previously reported cohort, we sought to determine (1) the probability of radial nerve motor recovery after operated humerus fractures, accounting for time since injury, and (2) the variables independently associated with timing of radial nerve recovery.
Methods: We retrospectively reviewed records of 53 patients who underwent humeral shaft fracture fixation with a radial nerve palsy with a nerve in continuity. The median age was 43 years (range 18 to 94), and 49% were male. Most palsies were present preoperatively (83%). Motor recovery was defined as Medical Research Council grade 3 or higher for wrist and/or finger extension. We performed Bayesian analysis with a prior probability of recovery derived from a large systematic review and incorporated cumulative recovery rates over time to calculate posterior probabilities of recovery at different time points.
Results: Using an anchor of 90% likelihood of overall recovery, the probability of recovery is greater than 50% (56%, range 48 to 62%) up to 7 months post-injury and drops below 20% (17%, range 13 to 21%) by 12 months (Figure 1). Survival analysis showed that half of the palsies recover just after 4 months. No variables were associated with timing of radial nerve recovery.
Conclusion: Understanding probabilities of recovery at different time points after injury may help surgeons and patients decide whether secondary nerve surgery or early tendon or nerve transfers will be beneficial.
