gms | German Medical Science

Objectives/Interrogation: To report patterns of iatrogenic nerve palsies referred to a tertiary peripheral nerve injury service.

Methods: This was a retrospective review of patients who presented with new-onset nerve palsy involving a motor or mixed motor/sensory nerve following an operation. Cutaneous neuromas alone were excluded.

Results and Conclusions: Between 2013 and 2018, 70 patients were referred to our unit with new-onset postoperative nerve palsies. There were 31 males and 39 females, with a mean age of 54 years (range 7-85). Apart from one case who was referred intraoperatively, the median duration from the index surgery to the date of referral was 6 months (range 7 days - 7 years). 24 (34%) referrals were made over 12 months postoperatively. The longest delay was seen in the spinal accessory nerve group with a mean delay of 2 years.

The nerves involved in the order of frequency were 14 radial, 10 axillary, 9 sciatic, 9 spinal accessory, 5 ulnar, 4 musculocutaneous, 3 posterior interosseous, 3 medial cord, 3 tibial, 5 median, 2 long thoracic, 1 C5 root, 1 common peroneal and 1 lateral cord.

The commonest index surgery was 26 (37%) arthroplasty, followed by 14 plating, 10 soft tissue excision, 4 wiring, 3 entrapment release, 3 removal of metalwork, 3 tenodesis, 2 arthroscopy, 2 nailing, 1 fusion, 1 manipulation and 1 thoracotomy.

9 patients (13%) showed signs of spontaneous recovery under review and were managed nonoperatively. 61 patients (87 %) proceeded with secondary surgery, including 44 neurolysis, 6 nerve graftings, 5 nerve transfers, 1 direct muscular neurotisation, 2 distal releases and 3 tendon transfers.

The false assumption that most postoperative nerve palsies would recover spontaneously still appears to be prevalent among surgeons, as reflected by the significant delay in referrals. Majority of these cases will warrant secondary reconstructive surgery and delay in treatment may have a negative impact on the ultimate outcome.