I think the best option is plating. You have to review the nerve and be sure that is not interposed between the two sides of the bone. With the nail you can demage more the nerve if it is interposed and if you ream the nail it can be a disaster.
I also think the best option is plating. You should confirm the status of radial nerve. You could choice thereby, open nail technique combined with neurolysis.
The most important point is confirm the status of nerve, but not which implant is better.
If operative option is taken then USG should be done along the arm to look for radial nerve entrapment.
Early exploration and repair of severed nerve have not been proved to produce any better results than repair at a later date (Campbell 12th ed)
Review article by Shao et al gives an algorithm for the same.
so nailing is also a good option with its own advantages.
Plating is recommended. Using IMN may surprize the surgeon by entrapment of the radial nerve between perfectly alighned fragments.
There are many ways to skin the cat and it depends on surgeon preference.
Pre-intervention imaging - either ultrasound or MRI would help in determining the situation of the nerve.
If it is indeed trapped, earlier release (this is neuropraxia, not axonotmesis or neurotmesis) is preferable, because recovery will start earlier.
Between plating and nailing, I would choose plating for the reasons mentioned in the above answers.
I think plating is best option because exploration of nerve is possible
yes indeed if imaging is available to resolve the situation then act accordingly. Neuroprexia is not an indication for surgery. Plating will be preferred in one really wants surgery.
I am agree with Yoshihiro Abe, that confirmation of radial nerve status is very important. Open nail technique in such cases combine with neurolysis is the best method. Intramedullary nail give better conditions for consolidation.
I normally use intramedullary nail for #shaft humerus. But if it is associated with a radial nerve injury, then open reduction (with radial nerve exploration) & plating is more preferred mode of treatment.
In a minimally displaced closed fracture shaft of humerus with radial nerve palsy,closed nailing is justified,as the nerve almost always recovers in a month's time.However in grossly displaced fracture/fracture involving lower third of humeral shaft it is better to opt for ORIF,using plate & screws,combined with exploration of the nerve.
i prefer plating for exploration of the radial nerve and plating is better than nailing in the humerus
In the past,I used to use Plate & screws for these fractures.However,with the advent of interlocking nails,I reserve plating for selective cases only as I had mentioned before.There are several distinct advantages of nailing versus plating.
I am yet to see a nonunion of humerus following nailing in our series,may be that the series is small.But,there is no need to open the fracture & explore the radial nerve in neuropraxia.
You don't necessarily need to do either. A low energy injury with a radial nerve palsy can be treated non operatively with a high expectation of recovery of nerve function.
If it is a high energy or open injury, then you need to explore the nerve, and plating would be the natural choice in that scenario.
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