Holstein-Lewis and Humerus shaft fractures associated with traumatic radial nerve palsy: a national survey among orthopedic trauma surgeons from Italy

BACKGROUND: The Holstein-Lewis fracture is a humerus shaft fracture characterized by a spiral pattern in which radial nerve could be injured due to its course around the humerus. Since there is no consensus in literature about the best treatment option and the timing, AO trauma Italy investigated the trend in the management of this type of fracture among orthopedic surgeons in Italy. A literature-based survey investigating the habits in conservative management, diagnosis, initial treatment, surgical approaches, fixation methods and postoperative management was released. The aim of this survey was to understand which is the trend regarding preoperative planning, treatments and which are the most important factors considered in the choice of surgical procedures.METHODS: A total of 122 orthopedic surgeons in Italy were interviewed in an online webinar. Agreement was found about most of the topics. Radial nerve palsy (RNP) should be attempted, to plan the best treatment option. If RNP is present a surgical exploration is recommended within 7-10 days. Microsurgical skills are required to perform a neurorrhaphy, otherwise it is possible to delegate it to a microsurgeon.RESULTS: Osteosynthesis with ORIF is the most preferred procedure by surgeons. If there is only a nerve contusion, a clinical follow-up of the patient with a possible second level examinations within 6-12 weeks are recommended. There was more disagreement about the surgical approaches with and without RNP. A final treatment algorithm has been proposed. The results of the survey reflected the trend in the current literature.CONCLUSIONS: According to the analysis of the literature and the findings of this survey, the authors have proposed an algorithm of treatment. The aim of this study was to give some guidelines in the correct choice management of this type of fractures.