Article
Traumatic Upper Extremity Nerve Lesions in Childhood – Management and Results
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Authors
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Martin U. Schuhmann
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
| Published: | April 21, 2016 |
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Outline
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Background: In children traumatic nerve injury of the upper extremities are much more frequent than those at the lower extremities. They occur, apart from obstetrical brachial plexus lesions, due to stretch because of dislocating fractures, due to direct trauma, iatrogenic or following cutting injuries. Management strategies and results of conservative and operative treatment are reviewed.
Materials and methods: 19 pediatric patients with 21 traumatic injuries of median (n=7), ulnar (n=10) or radial nerve (n=4) were included in a retrospective analysis.
Results: 7 patients had median nerve lesion, 2 after cutting injury at the wrist, 5 after supracondylar humerus fracture (ScH#). The cutting wrist level injuries underwent transplantation or early secondary end-to-end repair as did one severe ScH#, were primary end-to-end repair was achieved. 8 of 10 ulnar nerve lesion were acquired as distraction injury with ScH# or olecranon fracture. 7 recovered spontaneously, one had neurolysis at 6 months, One patient suffered iatrogenic ⅔ ulnar transsection injury all the elbow and one cutting transection at the forearm.Both were repaired by dural nerve transplants. There were 4 radial nerve lesions, 3 of them after ScH# as stretch injury with spontaneous recovery. In one the profound branch was severely injured and needed graft repair.
All patients experienced a recovery reaching total or near total restitution of sensory and motor function. There was no difference between surgical and conservative cases.
Conclusion: All traumatic nerve lesions in children should be followed in a specialized clinic in regular intervals for clinical and EMG surveillance of reinnervation. If there is evidence of nerve transsection (open injury or iatrogenic accident), primary or early secondary repair (within weeks) is mandatory. In closed distraction injury, like due to ScH#, patients are closely followed. If there is no convincing reinnervation at 6 months, open neurolysis and if necessary transplant repair is mandatory. If surgical intervention is necessary and performed in time, the results in children are very satisfactory and seem to be better than in adults.
