Postoperative Radial Nerve Palsy After Surgical Fixation of Humeral Shaft Fractures: A Systematic Review of Management and Functional Outcomes

Radial nerve palsy (RNP) is a clinically important complication of surgical fixation of humeral shaft fractures and may result in wrist drop, impaired hand function, and prolonged disability.This systematic review evaluated the incidence, risk factors, management, neurological recovery, and functional outcomes of postoperative RNP.PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library were searched from inception to September 2026.Primary clinical studies evaluating postoperative RNP following surgical fixation of humeral shaft fractures were included.Data regarding fracture characteristics, fixation technique, neurological findings, management, recovery, and functional outcomes were extracted, and methodological quality was assessed using appropriate risk of bias tools.Ten primary studies were included.Postoperative RNP was reported across the included studies, with neurological recovery generally favorable, although recovery frequently required several months.Reported incidence estimates varied across studies and depended on the population at risk and the definition of postoperative palsy.Postoperative RNP remains an important complication of humeral shaft fracture fixation.Standardized neurological assessment and prospective multicenter studies are required to better define risk factors and optimize management and recovery.