The radial nerve bridging plate technique for humeral shaft fractures: an approach facilitating plate removal without impeding fracture union - a case series.

BACKGROUND: Removing a plate of the humeral shaft with the radial nerve on top of the plate is challenging and carries a high risk for iatrogenic radial nerve palsy (iRNP). This study aimed to assess the incidence of iRNPs following plate removal of a radial nerve bridging plate (RNBP) and to evaluate outcomes of this RNBP in treatment of a humeral shaft fracture. METHODS: This was a single-center retrospective case series. Patients treated between May 2013 and December 2025 with a RNBP for a humeral shaft fracture or nonunion were included. The primary outcome measure was the incidence of iRNP after removal of the RNBP. Secondary outcome measures were the incidence of iRNP, malunion and nonunion after primary surgery. RESULTS: Of 48 included patients, the mean follow-up duration was 24 months. In 11 patients the plate was removed, no iRNP occurred in these patients. Of 41 patients who had no primary RNP after the fracture, seven patients experienced a temporary iRNP after primary surgery. All of the RNPs fully recovered with a mean recovery time of 12.3 weeks (range: 1-32). There were three nonunions, one of which was a pathological fracture, and one was a nonunion of a surgical neck fracture in a multilevel fracture. CONCLUSION: The RNBP technique allows safe and uneventful removal of the RNBP without iRNP, while maintaining the efficacy of plate fixation to treat humeral shaft fractures. It facilitates the decision to remove an implant if it seems indicated without risk of iatrogenic nerve damage.