Fracture related ulnar and sciatic nerve transections: a report of two cases and literature review

Payne, Russell; Sieg, Emily; Patrick, Nathan; Darowish, Michael; Rizk, Elias; Langan, Sara; Harbaugh, Kimberly

doi:10.1007/s00381-018-3961-0

Cited by 4 publications

(7 citation statements)

References 45 publications

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“…Studies have shown poor results with nerve graft repair of transected sciatic nerve, both at the buttock and thigh level, particularly in adult patients (although pediatric patients tend to do better). 3,15,16 In this case particularly, given the >7-cm gap and the proximal site of injury, we felt that using autograft from bilateral sural nerves would yield limited recovery. What we found in this case was that our patient tolerated the femur shortening, insertion of growing rod, and subsequent removal very well.…”

Section: Discussionmentioning

confidence: 96%

“…In the setting of sciatic nerve transections occurring proximally in the thigh or buttocks, prognosis is poor. 3,15,16 Novel treatment algorithms in this setting may lead to better outcomes. In this article, we present a novel technique involving femur shortening, followed by insertion of an expandable rod to facilitate direct end-to-end tension-free sciatic nerve repair.…”

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confidence: 99%

“…1,2 Injuries that occur in conjunction with femur fractures are rare but have been reported as well. [3][4][5][6] Electrodiagnostics and imaging can be useful to fully elucidate the extent of nerve injury, 7 and early mobilization is used to prevent contractures. 8 When surgery is warranted, as in the case of high-grade nerve injuries, multiple algorithms exist.…”

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confidence: 99%

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Novel Approach of Femur Shortening With Insertion of Expandable Rod to Achieve End-to-End Repair of Sciatic Nerve Laceration

Lubelski

Halsey

Suk

et al. 2022

Operative Neurosurgery

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BACKGROUND:Sciatic nerve injuries are challenging for diagnosis and treatment. Particularly in proximally located high-grade injuries, neurorrhaphy often has poor outcomes. Most advocate autologous grafting and some more recently have suggested the value of knee flexion braces to facilitate end-to-end repair.OBJECTIVE:To describe a case of femur shortening to facilitate tension-free, end-to-end sciatic nerve neurorrhaphy.METHODS:The patient was a 17-year-old man who was injured by the propeller of a motor boat and suffered a series of lacerations to both lower extremities including transection of his right sciatic nerve in the proximal thigh. After extensive mobilization of the nerve, a greater than 7-cm gap was still present. The patient was treated with femur shortening to facilitate end-to-end coaptation. He subsequently had an expandable rod placed which was lengthened 1 mm per day until his leg length was symmetric.RESULTS:Within 7 months postoperatively, the patient had an advancing Tinel sign and paresthesias to the dorsum of his foot. Nine months postoperatively, he had early mobility in his plantarflexion.CONCLUSION:We present a novel method of femur shortening with insertion of an expandable rod to facilitate direct end-to-end and tension-free sciatic nerve neurorrhaphy in a proximally located injury. Furthermore, larger scale and comparative studies are warranted to further explore this and other techniques.

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Section: Discussionmentioning

confidence: 96%

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confidence: 99%

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confidence: 99%

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Novel Approach of Femur Shortening With Insertion of Expandable Rod to Achieve End-to-End Repair of Sciatic Nerve Laceration

Lubelski

Halsey

Suk

et al. 2022

Operative Neurosurgery

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“…Liegt bildgebend der dringende Verdacht für eine Durchtrennung oder ein Kontinuitätsneurom vor, ist eine baldige operative Versorgung anzustreben [8,10,[13][14][15] In der hier untersuchten Kohorte betrug der durchschnittliche Zeitraum bis zur chirurgischen Freilegung 122,2 ± 85 Tage und folgt damit dieser Empfehlung.…”

Section: Diskussionunclassified

Funktionelle Ergebnisse peripherer Nervenverletzungen nach kindlichen suprakondylären Humerusfrakturen: Vergleich operativer und konservativer Behandlung

Deininger,

Antoniadis,

Pedro

2024

Handchir Mikrochir Plast Chir

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ZusammenfassungSuprakondyläre Humerusfrakturen sind die häufigsten Ellbogenfrakturen im Kindesalter bis 10 Jahre. Die Inzidenz von assoziierten Nervenverletzungen variiert je nach Angaben bis zu 15%. Traumatische und iatrogene Läsionen betreffen hauptsächlich den N. ulnaris. Die Regeneration peripherer Nerven ist im Kindesalter vergleichsweise besser. In der vorliegenden Arbeit werden die funktionellen Ergebnisse nach operativer und konservativer Therapie von Nervenverletzungen bei Kindern nach suprakondylären Frakturen verglichen und auf Einflussfaktoren untersucht. Bei dieser retrospektiven Vergleichsstudie wurden klinische Daten kindlicher Nervenverletzungen nach suprakondylären Humerusfrakturen, welche in einem Zeitraum von 13 Jahren (2008–2021) behandelt wurden, ausgewertet. Eingeschlossen wurden Kinder, welche aufgrund ausbleibender neurologischer/neurophysiologischer Besserung bis 6 Monate nach Trauma operativ (Neurolysen, autologe Rekonstruktion) behandelt wurden oder bei rückläufiger Symptomatik im gleichen Zeitraum konservativ nachbeobachtet wurden. Alle Patienten wurden im Verlauf multidisziplinär behandelt. 48 Patienten (26 weiblich/22 männlich) mit Nervenverletzungen wurden in diese Studie eingeschlossen. Alle Patienten erhielten in der Vorgeschichte eine operative Behandlung mit Kirschner-Draht Spickung aufgrund dislozierter Frakturen. Das mittlere Alter betrug 7±2 Jahre. Die initiale Symptomatik waren hochgradige motorische Ausfälle bei allen Patienten und sensible Defizite in 87,5% (n=42). Am häufigsten waren isolierte Läsionen des N. ulnaris (n=24, 50%). Bei 21 Patienten wurde der Nerv neurolysiert und bei 15 zusätzlich nach volar verlagert. Bei 7 Kindern erfolgte eine autologe Rekonstruktion und 2 erhielten ein Split Repair. Postoperativ war bei allen Patienten eine signifikante Verbesserung der motorischen Funktion zu verzeichnen. Trotz vergleichbar hochgradiger motorischer Ausfälle bei der Erstvorstellung wurden weitere 20 Kinder aufgrund der rückläufigen neurologischen Ausfälle konservativ therapiert. Sie zeigten vergleichbar gute funktionelle Ergebnisse. In beiden Gruppen waren keine schwerwiegenden Komplikationen verzeichnet worden. Die durchschnittliche Nachbeobachtungszeit betrug 377,25±524,87 Tage. Die präsentierte Studie zeigt exzellente funktionelle Ergebnisse nach der operativen Behandlung kindlicher Nervenverletzungen ohne schwere Komplikationen. Kinder mit vergleichsweise hochgradigen Läsionen bei der initialen Vorstellung haben auch ohne Operation eine gute Chance für eine komplette Spontanremission. Aus diesem Grund sollte die Operationsindikation bei Kindern sehr überlegt gestellt werden.

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“…Fractures have a negative impact on children and young people in multiple ways. [19][20][21][22][23][24][25] Given the increasing trend of methylphenidate uses all over the world over the past 20 years, 3,26 it is necessary to understand the relationship between the risk of fractures and methylphenidate use, to address the knowledge gap and to provide clinical guidance. Although several observational studies using between-subject design 17,18,27,28 have been conducted to investigate the association between the use of methylphenidate and the risk of fractures, they have yielded mixed results.…”

Section: Introductionmentioning

confidence: 99%

Treatment with methylphenidate and the risk of fractures among children and young people: A systematic review and self‐controlled case series study

Gao

Man

Min

et al. 2023

Brit J Clinical Pharma

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Animal studies suggest that methylphenidate treatment for around 3 months may lead to less mineralized and weaker appendicular bones. A systematic review was conducted to summarize the evidence from observational studies, and a selfcontrolled case series study was used to compare the risk before and after treatment initiation.Methods: Literature search was conducted using PubMed, Embase and the Cochrane Library to identify observational studies on methylphenidate and fractures. We also conducted a self-controlled case series study with individuals aged 5-24 years who received methylphenidate treatment and experienced fractures from 2001 to 2020 in Hong Kong. Incidence rate ratios and 95% confidence intervals were calculated by comparing the incidence rate in the methylphenidate-exposed period compared with nonexposed period.Results: Six cohort studies and 2 case-control studies were included in the systematic review. For all-cause fractures, studies found a 39-74% lower risk in treatedattention deficit hyperactivity disorder (ADHD) group compared with untreated ADHD but no difference between stimulants and nonstimulants. Differences between sexes and treatment duration were also found-significant results were shown in males and those with longer treatment duration. Among 43 841 individuals with ADHD medication before the year 2020, 2023 were included in the selfcontrolled case series analysis. The risks of fractures were lower by 32-41% in different treatment periods when compared with 6 months before treatment initiation.

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Fracture related ulnar and sciatic nerve transections: a report of two cases and literature review

Cited by 4 publications

References 45 publications

Novel Approach of Femur Shortening With Insertion of Expandable Rod to Achieve End-to-End Repair of Sciatic Nerve Laceration

Novel Approach of Femur Shortening With Insertion of Expandable Rod to Achieve End-to-End Repair of Sciatic Nerve Laceration

Funktionelle Ergebnisse peripherer Nervenverletzungen nach kindlichen suprakondylären Humerusfrakturen: Vergleich operativer und konservativer Behandlung

Treatment with methylphenidate and the risk of fractures among children and young people: A systematic review and self‐controlled case series study

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