Editor,A 29-year-old female sustained a closed, comminuted fracture of her left midshaft humerus () with an associated radial nerve palsy, disruption of her right sacro-iliac joint with an associatedfracture of the right superior pubic ramus and a stable first cervical vertebral fracture as the result of a highspeed road traffic accident. The pelvic injury was stabilised using two sacro-iliac screws and a halo-vest applied in order to manage her cervical spine fracture. A decision was taken to proceed with operative fixation of her left humeral shaft fracture to assist with postoperative mobilisation.Preoperative anteroposterior and lateral radiographs of left humerus.The humeral shaft fracture was exposed via an anterolateral approach. The fracture fragments were noted to be widely separated with significant periosteal stripping and soft tissue disruption. The radial nerve was found to be completely transected just proximal to the level of the fracture. The humeral fracture was stabilised using a narrow dynamic compression plate (). A direct end-to-end nerve repair was performed once fracture stability had been achieved. Postoperatively she was referred for splinting and upper limb rehabilitation. The pelvic and cervical spine injuries healed without complication and the left humeral shaft fracture proceeded satisfactorily to bony union. Approximately 11 months post-injury, the patient regained full recovery of her left radial nerve motor and sensory functions ().Postoperative anteroposterior and lateral radiographs of left humerus.Clinical pictures demonstrating active left wrist extension and active extension of the fingers and thumb left hand.Approximately 11% of patients with a closed humeral shaft fracture develop a radial nerve palsy with spontaneous recovery of nerve function occurring in approximately 70% of cases and hence the presence of a radial nerve palsy at the time of a closed humeral shaft fracture is not an absolute indication for surgical exploration. Middle third humeral fractures have the highest incidence of nerve injury because the nerve lies immediately adjacent to the periosteum in this region . Closed fractures are more commonly associated with a neurapraxia, whereas neurotemesis is more common in open fractures,.Leucht et al. reported two cases of radial nerve transection associated with a closed humeral shaft fracture. Both patients underwent operative fixation of their humeral fracture due to their associated injuries and at the time of surgery transection of the radial nerve was noted. The authors concluded that without the additional injuries the two patients would have been candidates for functional bracing with the result that the radial nerve transection would have been missed.Non-operative treatment of closed humeral shaft fractures usually leads to a satisfactory outcome even in the presence of a radial nerve palsy. However, some patients may have a radial nerve transection which will be missed if their fracture is treated conservatively. We suggest that the possibility of radial nerve transection should be considered in closed humeral shaft fractures with an associated radial nerve palsy which occur as a result of high-energy trauma or those fractures where there is marked displacement of the bone fragments.