Peripheral Nerve Injuries in Children

Česká verzia

Authors: I. Humhej; M. Sameš
Authors place of work: Neurochirurgická klinika UJEP, Masarykova nemocnice v Ústí nad Labem o. z., Krajská zdravotní a. s. přednosta prof. MUDr. M. Sameš, CSc.
Published in the journal: Čes-slov Pediat 2015; 70 (1): 20-28.
Category: Original Papers

Summary

Aim of the study:
Purpose of this study is to evaluate peripheral nerve (PN) regeneration after microsurgical reconstruction in our series of PN injuries in children, to identify the best surgical technique and its timing and to describe the post-operative care and the follow-up schedule. The pitfalls and the alternate management if the primary surgical reconstruction fails are provided.

Material and methods:
We retrospectively evaluated a series of children treated at our institution between 1999 and 2012. In this 14-year period 67 lesions in 60 patients (45 males, 15 females) were identified. Mean age was 12.3 years. 44 injuries constituted the completely transected PN, 20 partially and 3 lesions were concluded as traction injuries. The median nerve was the most frequently severed, followed by the ulnar nerve, typically at the wrist/distal forearm. The most common cause was a fall through the glass door. 48 lesions (80%) were treated immediately, 7 (12%) in a delayed fashion and 5 (8%) late. Direct microsuture was performed in 54 (81%) lesions; exoneurolysis in 6 (9%); and the autograft interposition was used in 7 lesions (10%).

Results:
26 children with 31 lesions completed 2-year follow-up period, 26 lesions in this subgroup (84%) recovered successfully (defined as motor function ≥M4 and sensory ≥S3 per B.M.R.C.). 5 (16%) recovered unsatisfactorily and in 4 of them we performed a secondary tendon transfer with good functional outcome.

Conclusion:
Peripheral nerves in children show remarkable regeneration capabilities and an immediate repair yields very good outcome. We advocate that the nerve repair should be performed in a timely manner to prevent more complicated reconstruction procedures with worse functional outcome.

Key words:
peripheral nerve, injury, suture, autologous graft, reconstruction, microsurgical technique, neurosurgery, physiotherapy, electrical stimulation, splint, tendon transfer

Zdroje

1. Birch R, Achan P. Peripheral nerve repairs and their results in children. Hand Clin 2000; 16 (4): 579–595.

2. Dubuisson A, Kline DG. Indication for peripheral nerve and brachial plexus surgery. Neurol Clin 1992; 10 (4): 935–951.

3. Mohler LR, Hanel DP. Closed fractures complicated by peripheral nerve injury. J Am Acad Orthop Surg 2006; 14 (1): 32–37.

4. Millesi H. Peripheral nerve injuries. Nerve sutures and nerve grafting. Scand J Plast Reconstr Surg Suppl 1982; 19: 25–37.

5. Zvěřina E, Stejskal L. Poranění periferních nervů. Praha: Avicenum, 1979.

6. Frykman GK. Peripheral nerve injuries in children. Orthop Clin North Am 1976; 7 (3): 701–716.

7. Kline DG, Hudson AR. Nerve Injuries. Operative Results for Major Nerve Injuries, Entrapments, and Tumors. USA: W.B. Saunders Company, 1995: 1–28.

8. Seddon HJ. Methods of investigating nerve injuries. Spec Rep Ser Med Res Counc (GB) 1954; 282: 1–15.

9. Murovic JA. Upper-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Centre literature review with comparison of the operative outcomes of 1837 Lousiana State University Health Sciences Center median, radial, and ulnar nerve lesions. Neurosurgery 2009; 65 (4 Suppl): A11–17.

10. Murovic JA. Lower-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Centre literature review with comparison of the operative outcomes of 806 Lousiana State University Health Sciences Center sciatic, common peroneal, and tibial nerve lesions. Neurosurgery 2009; 65 (4 Suppl): A18–23.

11. Sames M, Benes V Jr. Results of regeneration after peripheral nerve injuries. Rozhl Chir 1993; 72 (8): 347–351.

12. Isaacs J. Major peripheral nerve injuries. Hand Clin 2013; 29 (3): 371–382.

13. Kaiser R, Haninec P. Degeneration and regeneration of the peripheral nerve. Cesk Fysiol 2012; 61 (1): 9–14.

14. Sames M, Blahos J Jr, Rokyta R, et al. Comparison of microsurgical suture with fibrin glue connection of the sciatic nerve in rabbits. Physiol Res 1997; 46 (4): 303–306.

15. Haninec P, Kaiser R. Operační léčba poranění plexus brachialis. Cesk Slov Neurol N 2011; 74/107 (5): 619–630.

16. Novak CB, Heyde RL. Evidence and techniques in rehabilitation following nerve injuries. Hand Clin 2013; 29 (3): 383–392.

17. Gordon T, Amirjani N, Edwards DC, et al. Brief post-surgical electrical stimulation accelerates axon regeneration and muscle reinervation without affecting the functional measures in carpal tunnel syndrome patients. Exp Neurol 2010; 223 (1): 192–202.

18. Saur K, Bartos R, Sames M. Results of reinnervation after peripheral nerve repair by a microsurgical technique used in 1996–1998. Acta Chir Orthop Traumatol Cech 2004; 71 (5): 297–302.

19. Humhej I, Sameš M, Saur K, et al. Results of the median and ulnar nerve regeneration after distal nerve injury treated with microsurgical technique in a 20 year period (1984–2003). J Hand Surg Eur 2008; 33E (Suppl 1): 51.

20. Ceynowa M, Mazurek T, Sikora T. Median and ulnar nerve grafting in children. J Pediatr Orthop B 2012; 21 (6): 525–528.

21. Legré R, Iniesta A, Toméi F, et al. Nerve injuries in children. Chir Main 2013; 32 (Suppl): S52–56.

22. Kaufman Y, Cole P, Hollier L. Peripheral nerve injuries of the pediatric hand: issues in diagnosis and management. J Craniofac Surg 2009; 20 (4): 1011–1015.

23. Vahvanen V, Gripenberg L, Nuutinen P. Peripheral nerve injuries of the hand in children. A follow-up study of 38 patients. Scand J Plast Reconstr Surg 1981; 15 (1): 49–51.

24. Engert J, Wilhelm K, Simon G. Nerve lesions following injuries of the upper limbs in childhood. Z Kinderchir Grenzgeb 1980; 30 (Suppl): 117–121.

25. Stoebner AA, Sachanandani NS, Borschel GH. Upper and lower extremity nerve injuries in pediatric missile wounds: a selective approach to management. Pediatr Surg Int 2011; 27 (6): 635–641.

26. Hosalkar HS, Matzon JL, Chang B. Nerve palsies related to pediatric upper extremity fractures. Hand Clin 2006; 22 (1): 87–98.

27. Amillo S, Mora G. Surgical management of neural injuries associated with elbow fractures in children. J Pediatr Orthop 1999; 19 (5): 573–577.