Postoperative radial nerve palsy in humeral shaft nonunion reconstruction: Can the lateral paratricipital approach prevent this common complication?

•Of those patients who underwent nonunion reconstruction of the humerus utilizing a lateral paratricipital approach, zero patients (0/16) developed a postoperative radial nerve palsy (RNP).•Our overall rate of postoperative radial nerve palsy is consistent with the current literature; however, to our knowledge, our study is the first to include, analyze, and report the rate of postoperative RNP in regards to utilizing the lateral paratricipital approach when addressing nonunion reconstruction of the humerus.•The data in our manuscript support the utilization of the lateral paratricipital approach as a surgeon controlled means of decreasing postoperative patient morbidity associated with postoperative RNP. Merits of this approach include triceps muscle preservation, radial nerve identification at the spiral groove, decompression of the nerve at the lateral intermuscular septum, and tension-free mobilization of the nerve for improved protection during manipulation and instrumentation.•There was an increased rate of RNP with a longer duration of time between initial treatment and nonunion reconstruction with use of the triceps splitting approach. This suggests that it may be advisable to utilize a lateral paratricipital, rather than triceps splitting approach, if a posterior approach is required when treating a nonunion in cases where there is a greater period of time from initial treatment to nonunion reconstruction.