Upper limb nerve injuries in developmental age

Abstract

Our series includes 105 children with peripheral nerve injuries of the upper limb due to trauma. The aim of this study is to validate our therapeutic approach to peripheral nerve injuries of the upper limb in children and to identify the suitable waiting time before surgical exploration. Case series examination included evaluation of (1) type of lesion; (2) topographical site of nerve injury; (3) motor and sensory outcome; (4) recovery time; (5) results after surgery. Open injuries (Sunderland V) received immediate treatment with direct suturing or nerve grafts or biological tubules in case of loss of nerve substance. After closed nerve injury, a waiting period of variable duration should precede surgery. Most of the cases had peripheral nerve injuries associated to fracture and cutting lesions followed by injuries due to other causes. Open or closed injuries of the median and radial nerves had a generally favorable prognosis, whereas ulnar nerve injuries (both isolated and associated) had a poor prognosis. Stable skeletal fixation is essential in fractures at risk of nerve involvement. During nerve exploration, secondary surgery interventions were never associated. In the absence of adequate clinical and instrumental response, the authors suggest to resort to nerve surgery at 6 months from injury to accelerate recovery time. Secondary surgery should be delayed as patient's recovery time can be very long. (c) 2009 Wiley-Liss, Inc. Microsurgery, 2009.

Factors predicting sensory and motor recovery after the repair of upper limb peripheral nerve injuries

“…Of these, 126 were selected for review of the full text after primary screening, and 67 were judged to meet the criteria for inclusion in the present study[78910111213141516171819202122232425262728293031323334353637383940414243444546474849505152535455565758596061626364656667686970717273]. …”

Intramedullary osteosynthesis for metaphyseal and diaphyseal humeral fractures in developmental age

“…However, if, after a 6-month period, there are no clinical or electrophysiological signs of recovery, surgical exploration and even possible surgical nerve repair are necessary [22]. However, if, after a 6-month period, there are no clinical or electrophysiological signs of recovery, surgical exploration and even possible surgical nerve repair are necessary [22].…”

Lower limb nerve injuries in children

“…It is important to stress that, in children, injury can be prevented through an accurate injection technique, taking into account sites other than the gluteal region (e.g., quadriceps) and using needles with suitable gauge. 18 In a previous report, 6 we classified peripheral nerve injuries into generic lesions and typical lesions: the first presenting features similar to those found in the adult, and the second occurring almost exclusively during the developmental ages and characterized by altered growth potential. Nerve injury of the lower limb can be defined as a typical lesion since it causes early growth alterations with unfavorable outcomes; the smaller is the child at the time of injury, the more severe are the skeletal deformities.…”

“…Even in our experience, nerve injury of the upper limb showed a more favorable outcome; however, in lower limb injuries in children the outcome is not as consistent. 6 The purpose of this paper is to underscore the seriousness of peripheral nerve injuries of lower limbs in children and to stress the importance of an early exploration of the injured nerve trunk to minimize unfavorable outcomes.…”