RESUMEN
OBJECTIVE: To investigate the prevalence of upper limb peripheral nerve injuries (PNI) in adult patients admitted to the intensive care unit (ICU) with acute respiratory distress syndrome (ARDS) undergoing prone positioning. METHODS: This systematic review with meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Four electronic databases including PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), The Cochrane Library, and EMBASE were searched from inception to January 2024. The quality of the included studies was evaluated according to the Joanna Briggs Institute Critical Appraisal Tools. A proportion meta-analysis was conducted to examine the combined prevalence of upper limb PNI among patients requiring prone positioning. RESULTS: A total of 8 studies (511 patients) were pooled in the quantitative analysis. All studies had a low or moderate risk of bias in methodological quality. The overall proportion of patients with upper limb PNI was 13% (95%CI: 5% to 29%), with large between-study heterogeneity (I2 = 84.6%, P<0.001). Both ulnar neuropathy and brachial plexopathy were described in 4 studies. CONCLUSION: During the COVID-19 pandemic, prone positioning has been used extensively. Different approaches among ICU teams and selective reporting by untrained staff may be a factor in interpreting the large variability between studies and the 13% proportion of patients with upper limb PNI found in the present meta-analysis. Therefore, it is paramount to stress the importance of patient assessment both after discharge from the ICU and during subsequent follow-up evaluations. IMPLICATIONS FOR CLINICAL PRACTICE: Specialized training is essential to ensure safe prone positioning, with careful consideration given to arms and head placement to mitigate potential nerve injuries. Therefore, healthcare protocols should incorporate preventive strategies, with patient assessments conducted by expert multidisciplinary teams.
Asunto(s)
Posicionamiento del Paciente , Traumatismos de los Nervios Periféricos , Síndrome de Dificultad Respiratoria , Extremidad Superior , Humanos , Posición Prona , Síndrome de Dificultad Respiratoria/etiología , Extremidad Superior/lesiones , Extremidad Superior/fisiopatología , Traumatismos de los Nervios Periféricos/etiología , Posicionamiento del Paciente/métodos , Unidades de Cuidados Intensivos/organización & administración , Unidades de Cuidados Intensivos/estadística & datos numéricos , COVID-19/complicacionesRESUMEN
Elbow arthroscopy is a useful tool that can be applied in a variety of surgical indications. However, performing the procedure safely demands a thorough understanding of the proximity of neurovascular structures around the elbow. Although nerve injuries in elbow arthroscopy are rare, complications can further be avoided by adhering to a set of principles designed to protect the surrounding neurovascular structures. Before making portals, the surgeon should palpate and mark the ulnar nerve to confirm its location in the groove. Next, the joint should be insufflated with fluid to distend the joint capsule and increase the distance between instruments and the anterior neurovascular structures. Anterior portals ideally should be made proximal to the medial and lateral epicondyles, thereby increasing distance from the median and radial nerve, respectively. Once in the joint, it is critical to stay oriented by maintaining instruments and the articular surfaces in the same view. Special caution should be exercised when in proximity to the capsule in the posteromedial gutter to protect the ulnar nerve. Similarly, the anterior inferior capsule should be approached with caution, as its violation puts branches of the radial nerve, specifically the posterior interosseous nerve, at risk. Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint.
Asunto(s)
Artroscopía , Articulación del Codo , Traumatismos de los Nervios Periféricos , Humanos , Artroscopía/métodos , Articulación del Codo/cirugía , Traumatismos de los Nervios Periféricos/prevención & control , Traumatismos de los Nervios Periféricos/etiología , Nervio Cubital/lesiones , Nervio Radial/lesiones , Nervio Radial/anatomía & histologíaRESUMEN
AIMS: Right phrenic nerve (RPN) injury is a disabling but uncommon complication of atrial fibrillation (AF) radiofrequency ablation. Pace-mapping is widely used to infer RPN's course, for limiting the risk of palsy by avoiding ablation at capture sites. However, information is lacking regarding the distance between the endocardial sites of capture and the actual anatomic RPN location. We aimed at determining the distance between endocardial sites of capture and anatomic CT location of the RPN, depending on the capture threshold. METHODS AND RESULTS: In consecutive patients undergoing AF radiofrequency ablation, we defined the course of the RPN on the electroanatomical map with high-output pacing at up to 50â mA/2â ms, and assessed RPN capture threshold (RPN-t). The true anatomic course of the RPN was delineated and segmented using CT scan, then merged with the electroanatomical map. The distance between pacing sites and the RPN was assessed. In 45 patients, 1033 pacing sites were analysed. Distances from pacing sites to RPN ranged from 7.5 ± 3.0â mm (min 1) when RPN-t was ≤10â mA to 19.2 ± 6.5â mm (min 9.4) in cases of non-capture at 50â mA. A distance to the phrenic nerve > 10â mm was predicted by RPN-t with a ROC curve area of 0.846 [0.821-0.870] (P < 0.001), with Se = 80.8% and Sp = 77.5% if RPN-t > 20â mA, Se = 68.0% and Sp = 91.6% if RPN-t > 30â mA, and Se = 42.4% and Sp = 97.6% if non-capture at 50â mA. CONCLUSION: These data emphasize the utility of high-output pace-mapping of the RPN. Non-capture at 50â mA/2â ms demonstrated very high specificity for predicting a distance to the RPN > 10â mm, ensuring safe radiofrequency delivery.
Asunto(s)
Fibrilación Atrial , Ablación por Catéter , Imagenología Tridimensional , Traumatismos de los Nervios Periféricos , Nervio Frénico , Valor Predictivo de las Pruebas , Humanos , Nervio Frénico/lesiones , Nervio Frénico/diagnóstico por imagen , Fibrilación Atrial/cirugía , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Anciano , Ablación por Catéter/métodos , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/prevención & control , Resultado del Tratamiento , Técnicas Electrofisiológicas Cardíacas , Tomografía Computarizada por Rayos X , Estimulación Cardíaca Artificial/métodos , Interpretación de Imagen Radiográfica Asistida por Computador , Potenciales de Acción , Curva ROCRESUMEN
BACKGROUND: High ulnar nerve injuries is known to have unfavorable motor outcomes compared to other peripheral nerve injuries in the upper extremity. Functional muscle recovery after peripheral nerve injury depends on the time to motor end plate reinnervation and the number of motor axons that successfully reach the target muscle. The purpose of this study is to assess the functional recovery, and complications following performing supercharge end-to-side (SETS) anastomosis for proximal ulnar nerve injuries. Our study focuses on the role of SETS in the recovery process of high ulnar nerve injury. PATIENT AND METHODS: This study is a prospective, single-arm, open-label, case series. The original proximal nerve pathology was dealt with according to the cause of injury, then SETS was performed distally. The follow-up period was 18 months. We compared the neurological findings before and after the procedure. A new test was used to show the effect of SETS on recovery by performing a Lidocaine proximal ulnar nerve block test. RESULTS: Recovery of the motor function of the ulnar nerve was evident in 33 (86.8%) patients. The mean time to intrinsic muscle recovery was 6.85 months ± 1.3, only 11.14% of patients restored protective sensation to the palm and finger and 86.8% showed sensory level at the wrist level at the end of the follow-up period. Lidocaine block test was performed on 35 recovered patients and showed no change in intrinsic hand function in 31 patients. CONCLUSION: SETS exhibit a remarkable role in the treatment of high ulnar nerve damage. SETS transfer can act as a nerve transfer that can supply intrinsic muscles by its fibers and allows for proximal nerve regeneration. We believe that this technique improves recovery of hand motor function and allows recovery of sensory fibers when combined with treating the proximal lesion. TRIAL REGISTRATION: Approved by Research Ethics Committee of Faculty of Medicine- Cairo University on 01/09/2021 with code number: MD-215-2021.
Asunto(s)
Transferencia de Nervios , Recuperación de la Función , Nervio Cubital , Humanos , Estudios Prospectivos , Nervio Cubital/lesiones , Nervio Cubital/cirugía , Adulto , Masculino , Femenino , Transferencia de Nervios/métodos , Persona de Mediana Edad , Adulto Joven , Traumatismos de los Nervios Periféricos/cirugía , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/fisiopatología , Resultado del Tratamiento , Estudios de Seguimiento , Regeneración Nerviosa/fisiología , AdolescenteRESUMEN
PURPOSE: This study aims to evaluate the long-term outcomes of saphenous nerve (SN) injuries from hamstring tendon harvesting during ACL reconstruction, focusing on clinical results and patient satisfaction after at least two years. Additionally, it investigates the incidence, recovery patterns, and impact of these injuries on functional outcomes, daily activities, and ACL re-rupture rates immediately post-surgery and at final follow-up. MATERIALS AND METHODS: A retrospective review was conducted on patients who had undergone ACL reconstruction with hamstring tendon grafts at a single institution between January 2015 and January 2020. The incidence of SN injuries was assessed immediately after surgery and at final follow-up. Additionally, the recovery rate and time were evaluated, and the impact of these injuries on functional outcomes was measured using the Lysholm Knee Score (LKS) and patient-reported effects on daily activities. RESULTS: Of the 159 patients analyzed, iatrogenic SN injuries were initially observed in 87 (54.7%) patients post-ACLR. By the final follow-up, paresthesia had resolved in 36 (22.6%) patients within an average of 11.1 months. Persistent SN injuries were recorded in 51 (32.1%) patients, affecting various extents of the infrapatellar branch (IPBSN) and the sartorial branch (SBSN) of the saphenous nerve. Patients with persistent SN injuries experienced a significant impact on daily activities and had lower LKS scores compared to those without injuries or with recovered injuries. Furthermore, a higher re-rupture rate was associated with persistent SN injuries. CONCLUSIONS: The study finds that SN injuries during hamstring graft harvesting for ACL reconstruction are common, with a significant portion of patients experiencing persistent sensory deficits for at least two years postoperatively. These injuries are observed to adversely affect patient satisfaction and functional outcomes and to increase the re-rupture rate.
Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior , Tendones Isquiotibiales , Enfermedad Iatrogénica , Humanos , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Reconstrucción del Ligamento Cruzado Anterior/métodos , Femenino , Masculino , Adulto , Estudios Retrospectivos , Tendones Isquiotibiales/trasplante , Adulto Joven , Pronóstico , Traumatismos de los Nervios Periféricos/etiología , Recolección de Tejidos y Órganos/efectos adversos , Recolección de Tejidos y Órganos/métodos , Adolescente , Estudios de Seguimiento , Persona de Mediana Edad , Satisfacción del Paciente , Recuperación de la Función , Incidencia , Resultado del TratamientoRESUMEN
Common fibular nerve (CFN) injury due to ankle fracture is an underreported complication. The authors have proposed that torsional injury to the ankle can be translated along the interosseous membrane (IOM), producing tension on the CFN at the fibular neck. A 23-year-old woman presented to our clinic for left foot drop. Three months prior, the patient sustained a fall with left ankle inversion injury while running. She was diagnosed with a minor ankle fracture and placed in an orthopaedic boot. Unfortunately, her swelling worsened and one week later the patient was diagnosed with foot drop, which was further corroborated with EMG studies showing severe CFN injury localizing to the fibular neck. Because of the lack of recovery, she underwent decompression of the CFN. She experienced immediate symptomatic relief. High resolution imaging in this case supports our previous mechanism for indirect trauma to the ankle resulting in CFN injury. (Journal of Surgical Orthopaedic Advances 33(1):053-055, 2024).
Asunto(s)
Fracturas de Tobillo , Imagen por Resonancia Magnética , Nervio Peroneo , Humanos , Femenino , Adulto Joven , Nervio Peroneo/lesiones , Nervio Peroneo/diagnóstico por imagen , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Traumatismos del Tobillo/diagnóstico por imagen , Traumatismos del Tobillo/cirugía , Descompresión Quirúrgica , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/diagnóstico por imagen , Peroné/lesiones , Peroné/diagnóstico por imagenRESUMEN
PURPOSE: Nerve transfers to restore or augment function after spinal cord injury is an expanding field. There is a paucity of information, however, on the use of nerve transfers for patients having undergone spine surgery. The incidence of neurologic deficit after spine surgery is rare but extremely debilitating. The purpose of this study was to describe the functional benefit after upper extremity nerve transfers in the setting of nerve injury after cervical spine surgery. METHODS: A single-center retrospective review of all patients who underwent nerve transfers after cervical spine surgery was completed. Patient demographics, injury features, spine surgery procedure, nerve conduction and electromyography study results, time to referral to nerve surgeon, time to surgery, surgical technique and number of nerve transfers performed, complications, postoperative muscle testing, and subjective outcomes were reviewed. RESULTS: Fourteen nerve transfers were performed in 6 patients after cervical spine surgery. Nerve transfer procedures consisted of a transfer between a median nerve branch of flexor digitorum superficialis into a biceps nerve branch, an ulnar nerve branch of flexor carpi ulnaris into a brachialis nerve branch, a radial nerve branch of triceps muscle into the axillary nerve, and the anterior interosseous nerve into the ulnar motor nerve. Average patient age was 55 years; all patients were male and underwent surgery on their left upper extremity. Average referral time was 7 months, average time to nerve transfer was 9 months, and average follow-up was 21 months. Average preoperative muscle grading was 0.9 of 5, and average postoperative muscle grading was 4.1 of 5 ( P < 0.00001). CONCLUSIONS: Upper extremity peripheral nerve transfers can significantly help patients regain muscle function from deficits secondary to cervical spine procedures. The morbidity of the nerve transfers is minimal with measurable improvements in muscle function.
Asunto(s)
Vértebras Cervicales , Transferencia de Nervios , Extremidad Superior , Humanos , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Transferencia de Nervios/métodos , Vértebras Cervicales/cirugía , Extremidad Superior/cirugía , Extremidad Superior/inervación , Adulto , Anciano , Resultado del Tratamiento , Femenino , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/cirugía , Recuperación de la Función , Traumatismos de la Médula EspinalRESUMEN
INTRODUCTION: The purpose of this study was to report the incidence of iatrogenic sural nerve injury in a large, consecutive sample of surgically managed ankle fractures and to identify factors associated with sural nerve injury and subsequent recovery. We hypothesize that a direct posterior approach may be associated with higher risk of iatrogenic sural nerve injury. METHODS: A retrospective cohort study of 265 skeletally mature patients who sustained ankle fractures over a 2-year period was done. All were treated with open reduction and internal fixation of fractured malleoli. Patient, injury, and treatment features were documented. The presence (n = 26, 9.8%) of sural nerve injury and recovery of sural nerve function were noted. RESULTS: All 26 sural nerve injuries were iatrogenic, occurring postoperatively after open reduction and internal fixation. Patients who sustained sural nerve injuries had more ankle fractures secondary to motor vehicle collisions (23.1% versus 9.2%), more associated trimalleolar fractures (69.2% versus 33.9%), and more Orthopaedic Trauma Association/AO 44B3 fractures (57.7% versus 25.1%), all P < 0.05. A posterior approach to the posterior malleolus through the prone position was used in 20.4% of patients. All 26 of the sural nerve injuries (100%) occurred when the patient was placed prone for a posterior approach, P < 0.001. Therefore, 26 of the 54 patients (48%) treated with a posterior approach sustained an iatrogenic sural nerve injury. 62% of patients had full recovery of sural nerve function with no residual numbness, and patients with nerve recovery had fewer associated fracture-dislocations (23.1% versus 100%, P = 0.003). CONCLUSIONS: A posterior approach for posterior malleolus fixation was associated with a 48% iatrogenic sural nerve injury rate, with 62% recovering full function within 6 months of injury. Morbidity of this approach should be considered, and surgeons should be cautious with nerve handling. LEVEL OF EVIDENCE: Level III, Therapeutic.
Asunto(s)
Fracturas de Tobillo , Fijación Interna de Fracturas , Enfermedad Iatrogénica , Nervio Sural , Humanos , Estudios Retrospectivos , Nervio Sural/lesiones , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Masculino , Fracturas de Tobillo/cirugía , Femenino , Adulto , Persona de Mediana Edad , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/epidemiología , Adulto Joven , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Incidencia , Estudios de Cohortes , Adolescente , Reducción Abierta/efectos adversos , Reducción Abierta/métodosRESUMEN
BACKGROUND: Prostate cancer (PCa) is the most common non-cutaneous malignancy in men and leads to the second most common cause of cancer related mortality in men. Early detection of PCa allows for a potentially curative intervention. Most men will live over a decade from the time of their PCa diagnosis. Thus, treatments must balance curative interventions with their impact on quality of life. Radical prostatectomy (RP) is one such potentially curative intervention but often leads to erectile dysfunction (ED) and urinary incontinence (UI). Approximately 90,000 RPs are performed each year in the USA. Post-operative ED and UI is thought to occur in part from traumatic peripheral nerve injury (TPNI) to the neurovascular bundles that surround the prostate. Thus, patients undergoing RP may be a population that would benefit from clinical studies that look at TPNI. METHODS: The study is a single-institution, double-blinded placebo-controlled, randomized clinical trial in which patients immediately post-RP receive either 4-aminopyrdine (4AP) or placebo in a 1:1 fashion. The primary outcome is evaluation of the efficacy of 4AP in accelerating the early return of baseline erectile and urinary function post-radical prostatectomy. DISCUSSION: This study is critical as it could reduce the morbidity associated with RP, a commonly performed operation, and identify a patient population that may greatly benefit into further TPNI research. TRIAL REGISTRATION: ClinicalTrials.gov NCT03701581. Prospectively registered on October 10, 2018.
Asunto(s)
Disfunción Eréctil , Traumatismos de los Nervios Periféricos , Prostatectomía , Neoplasias de la Próstata , Incontinencia Urinaria , Humanos , Masculino , Persona de Mediana Edad , Método Doble Ciego , Disfunción Eréctil/etiología , Disfunción Eréctil/tratamiento farmacológico , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Prostatectomía/efectos adversos , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Recuperación de la Función , Resultado del Tratamiento , Incontinencia Urinaria/etiologíaRESUMEN
BACKGROUND: Iatrogenic injury to the infrapatellar branches of saphenous nerve is a common complication following tibial nailing. This lesion seems to be directly related to the surgical approach adopted for nail insertion. The aim of the present study was to systematically review the current literature in order to assess the eventual superiority of one surgical approach for tibial nailing over the others in limiting the neurological impairment related to infrapatellar branch injury. MATERIALS AND METHODS: The available literature was systematically screened searching papers dealing with iatrogenic injury to the infrapatellar branch of saphenous nerve after intramedullary tibial nailing. The terms "Saphenous" and "Infrapatellar branch" were used in combination with "intramedullary nailing" and "tibial fractures", supplying no limits regarding the publication year. Only publications in English were considered. Case reports, technical notes, instructional course, literature reviews, biomechanical and/ or in vitro studies were all excluded. Coleman methodological score was performed in all the retained articles. RESULTS: Four articles matched the inclusion criteria. There were one original article and three retrospective study. Hypoesthesia and a larger extension of the area of sensory-loss were more frequently observed after vertical incision approach in three out of four articles. A trend towards a lower rate of iatrogenic nerve damage using a transverse incision was found in the remaining one, without any statistical significance. CONCLUSIONS: In order to avoid infrapatellar nerve lesion, horizontal or oblique incisions or percutaneous approaches should be favored, although in some cases a longitudinal incision is required. Limited-extension incisions could minimize the risk and the incidence of this complication.
Asunto(s)
Fijación Intramedular de Fracturas , Enfermedad Iatrogénica , Traumatismos de los Nervios Periféricos , Fracturas de la Tibia , Humanos , Fracturas de la Tibia/cirugía , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/métodos , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/prevención & control , Clavos Ortopédicos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & controlRESUMEN
AIMS: Phrenic nerve injury (PNI) is the most common complication during cryoballoon ablation. Currently, two cryoballoon systems are available, yet the difference is unclear. We sought to compare the acute procedural efficacy and safety of the two cryoballoons. METHODS: This prospective observational study consisted of 2,555 consecutive atrial fibrillation (AF) patients undergoing pulmonary vein isolation (PVI) using either conventional (Arctic Front Advance) (AFA-CB) or novel cryoballoons (POLARx) (POLARx-CB) at 19 centers between January 2022 and October 2023. RESULTS: Among 2,555 patients (68.8 ± 10.9 years, 1,740 men, paroxysmal AF[PAF] 1,670 patients), PVIs were performed by the AFA-CB and POLARx-CB in 1,358 and 1,197 patients, respectively. Touch-up ablation was required in 299(11.7%) patients. The touch-up rate was significantly lower for POLARx-CB than AFA-CB (9.5% vs. 13.6%, p = 0.002), especially for right inferior PVs (RIPVs). The touch-up rate was significantly lower for PAF than non-PAF (8.8% vs. 17.2%, P < 0.001) and was similar between the two cryoballoons in non-PAF patients. Right PNI occurred in 64(2.5%) patients and 22(0.9%) were symptomatic. It occurred during the right superior PV (RSPV) ablation in 39(1.5%) patients. The incidence was significantly higher for POLARx-CB than AFA-CB (3.8% vs. 1.3%, P < 0.001) as was the incidence of symptomatic PNI (1.7% vs. 0.1%, P < 0.001). The difference was significant during RSPV (2.5% vs. 0.7%, P < 0.001) but not RIPV ablation. The PNI recovered more quickly for the AFA-CB than POLARx-CB. CONCLUSIONS: Our study demonstrated a significantly higher incidence of right PNI and lower touch-up rate for the POLARx-CB than AFA-CB in the real-world clinical practice.
Asunto(s)
Fibrilación Atrial , Criocirugía , Traumatismos de los Nervios Periféricos , Nervio Frénico , Venas Pulmonares , Sistema de Registros , Humanos , Nervio Frénico/lesiones , Masculino , Femenino , Fibrilación Atrial/cirugía , Fibrilación Atrial/epidemiología , Venas Pulmonares/cirugía , Anciano , Criocirugía/efectos adversos , Criocirugía/métodos , Estudios Prospectivos , Incidencia , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/epidemiología , Traumatismos de los Nervios Periféricos/prevención & control , Persona de Mediana Edad , Resultado del Tratamiento , Ablación por Catéter/efectos adversosRESUMEN
Aims: Lateral femoral cutaneous nerve (LFCN) injury is a complication after periacetabular osteo-tomy (PAO) using an anterior approach, which might adversely affect the outcome. However, no prospective study has assessed the incidence and severity of this injury and its effect on the clinical outcomes over a period of time for longer than one year after PAO. The aim of this study was to assess the incidence and severity of the symptoms of LFCN injury for ≥ three years after PAO and report its effect on clinical outcomes. Methods: A total of 40 hips in 40 consecutive patients who underwent PAO between May 2016 and July 2018 were included in the study, as further follow-up of the same patients from a previous study. We prospectively evaluated the incidence, severity, and area of symptoms following LFCN injury. We also recorded the clinical scores at one year and ≥ three years postoperatively using the 36-Item Short Form Health Survey (SF-36) and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) scores. Results: A total of 20 patients (50%) had symptoms of a LFCN injury at one year after PAO. At ≥ three years postoperatively, the symptoms had completely resolved in seven of these patients and 13 (33%) had persistent symptoms. The severity and area of symptoms did not significantly differ between one and ≥ three years postoperatively. The JHEQ showed significant differences in the patient satisfaction and mental scores between those with and those without sypmtoms of LFCN injury at ≥ three years postoperatively, while there was no significant difference in the mean SF-36 scores. Conclusion: The incidence of LFCN injury after PAO using an anterior approach is high. The outcome of PAO, ≥ three years postoperatively, is poorer in patients with persistent symptoms from a perioperative LFCN injury, in that patient satisfaction and mental health scores are adversely affected.
Asunto(s)
Acetábulo , Osteotomía , Traumatismos de los Nervios Periféricos , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Incidencia , Adulto , Osteotomía/efectos adversos , Osteotomía/métodos , Acetábulo/cirugía , Acetábulo/lesiones , Estudios Prospectivos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/epidemiología , Persona de Mediana Edad , Nervio Femoral/lesiones , Adulto Joven , Resultado del Tratamiento , AdolescenteRESUMEN
BACKGROUND: Posterior retroperitoneoscopic adrenalectomy has several advantages over transabdominal laparoscopic adrenalectomy regarding operating time, blood loss, postoperative pain, and recovery. However, postoperatively several patients report chronic pain or hypoesthesia. We hypothesized that these symptoms may be the result of damage to the subcostal nerve, because it passes the surgical area. METHODS: A prospective single-center case series was performed in adult patients without preoperative pain or numbness of the abdominal wall who underwent unilateral posterior retroperitoneoscopic adrenalectomy. Patients received pre- and postoperative questionnaires and a high-resolution ultrasound scan of the subcostal nerve and abdominal wall muscles was performed before and directly after surgery. Clinical evaluation at 6 weeks was performed with repeat questionnaires, physical examination, and high-resolution ultrasound. Long-term recovery was evaluated with questionnaires, and photographs from the patients were examined for abdominal wall asymmetry. RESULTS: A total of 25 patients were included in the study. There were no surgical complications. Preoperative visualization of the subcostal nerve was possible in all patients. At 6 weeks, ultrasound showed nerve damage in 15 patients, with no significant association between nerve damage and postsurgical pain. However, there was a significant association between nerve damage and hypoesthesia (p = 0.01), sensory (p < 0.001), and motor (p < 0.001) dysfunction on physical examination. After a median follow-up of 18 months, 5 patients still experienced either numbness or muscle weakness, and one patient experienced chronic postsurgical pain. CONCLUSION: In this exporatory case series the incidence of postoperative damage to the subcostal nerve, both clinically and radiologically, was 60% after posterior retroperitoneoscopic adrenalectomy. There was no association with pain, and the spontaneous recovery rate was high.
Asunto(s)
Adrenalectomía , Laparoscopía , Ultrasonografía , Humanos , Masculino , Femenino , Adrenalectomía/métodos , Adrenalectomía/efectos adversos , Estudios Prospectivos , Persona de Mediana Edad , Laparoscopía/métodos , Espacio Retroperitoneal/diagnóstico por imagen , Espacio Retroperitoneal/cirugía , Adulto , Ultrasonografía/métodos , Anciano , Dolor Postoperatorio/etiología , Nervios Intercostales/diagnóstico por imagen , Traumatismos de los Nervios Periféricos/etiologíaRESUMEN
PURPOSE: The open Trillat Procedure described to treat recurrent shoulder instability, has a renewed interest with the advent of arthroscopy. The suprascapular nerve (SSN) is theoretically at risk during the drilling of the scapula near the spinoglenoid notch. The purpose of this study was to assess the relationship between the screw securing the coracoid transfer and the SSN during open Trillat Procedure and define a safe zone for the SSN. METHODS: In this anatomical study, an open Trillat Procedure was performed on ten shoulders specimens. The coracoid was fixed by a screw after partial osteotomy and antero-posterior drilling of the scapular neck. The SSN was dissected with identification of the screw. We measured the distances SSN-screw (distance 1) and SSN-glenoid rim (distance 2). In axial plane, we measured the angles between the glenoid plane and the screw (α angle) and between the glenoid plane and the SSN (ß angle). RESULTS: The mean distance SSN-screw was 8.8 mm +/-5.4 (0-15). Mean α angle was 11°+/-2.4 (8-15). Mean ß angle was 22°+/-6.7 (12-30). No macroscopic lesion of the SSN was recorded but in 20% (2 cases), the screw was in contact with the nerve. In both cases, the ß angle was measured at 12°. CONCLUSION: During the open Trillat Procedure, the SSN can be injured due to its anatomical location. Placement of the screw should be within 10° of the glenoid plane to minimize the risk of SSN injury and could require the use of a specific guide or arthroscopic-assisted surgery.
Asunto(s)
Inestabilidad de la Articulación , Traumatismos de los Nervios Periféricos , Articulación del Hombro , Humanos , Articulación del Hombro/cirugía , Articulación del Hombro/inervación , Inestabilidad de la Articulación/cirugía , Hombro , Escápula/cirugía , Escápula/inervación , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/prevención & control , Traumatismos de los Nervios Periféricos/cirugía , Artroscopía/efectos adversosRESUMEN
Supracondylar humerus fractures are the most common elbow fractures in children up to 10 years of age. The incidence of associated nerve injuries varies up to 15% depending on the data. Traumatic and iatrogenic lesions mainly affect the ulnar nerve. The regeneration of peripheral nerves is comparatively better in childhood. In the present study, the functional results after surgical and conservative treatment of nerve injuries in children after supracondylar fractures were compared and analyzed for influencing factors. In this retrospective comparative study, clinical data of pediatric nerve injuries following supracondylar humerus fractures treated over a period of 13 years (2008-2021) were analyzed. Children who were treated surgically (neurolysis, autologous reconstruction) due to insufficient clinical/neurophysiological improvement within 6 months after trauma or who were followed up conservatively in case of regression of symptoms within 6 months after trauma were included. All patients underwent multidisciplinary follow-up. 48 patients (26 female/22 male) with nerve injuries were included in this study. All patients had a history of surgical treatment with K- wire fixation due to severe dislocated fractures. The mean age was 7±2 years. The initial symptoms were severe motor deficits in all patients and sensory deficits in 87.5% (n=42). Isolated lesions of the ulnar nerve were most common (n=24, 50%). The nerve was neurolysed in 21 patients and additionally transferred to the volar side in 15. Nerve grafting was performed in 7 children and split repair in 2. Postoperatively, there was a significant improvement in motor function in all patients. Despite comparably severe motor deficits at initial presentation, further 20 children were treated conservatively due to the regression of neurological deficits. They showed comparably good functional results. No serious complications were recorded in either group. The average follow-up time was 377.25±524.87 days. The presented study shows excellent functional results after surgical treatment of pediatric nerve injuries without severe complications. Children with comparatively high-grade lesions at initial presentation have a good chance of complete spontaneous remission even without surgery. For this reason, the indication for surgery in children should be very carefully considered.
Asunto(s)
Fracturas del Húmero , Traumatismos de los Nervios Periféricos , Niño , Humanos , Masculino , Femenino , Preescolar , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/cirugía , Estudios Retrospectivos , Tratamiento Conservador/efectos adversos , Fracturas del Húmero/cirugía , Fracturas del Húmero/complicaciones , Hilos Ortopédicos/efectos adversos , Resultado del Tratamiento , Fijación Interna de FracturasRESUMEN
BACKGROUND: Nerve injury is one of the most serious complications of total hip arthroplasty (THA). It is suspected to be a result from nerve compression or direct injury caused by an acetabular retractor. The anatomical relationship between the acetabular rim and the femoral and sciatic nerves, including hip motion, has not been investigated. This study aimed to identify the optimal position for retractor insertion during THA to prevent nerve damage. METHODS: A total of 28 hip joints from 14 freshly frozen cadavers were used. Using an anterolateral approach, each cadaver was immobilised in the lateral decubitus position and deployed to measure the distance between the nerves and the acetabular rim, while the hip joint was changed to the extension, neutral, and flexion positions. RESULTS: Three femoral nerves were closest to the anterior margin of the acetabulum at 90° and 120° of extension and farthest away at 30° of flexion. The sciatic nerve was closest to the posterior margin of the acetabulum at 90° and 120° of flexion and farthest away at 30° and 150° of extension compared with the other points. CONCLUSIONS: To prevent nerve damage during THA, we suggest that the retractor be inserted at the points where the nerves are the farthest away, such as at 30° and 150°. The femoral and sciatic nerves vary in their movements depending on the hip position. Therefore, the safe insertion of a retractor is recommended for hip flexion of the femoral nerve and extension of the sciatic nerve. Additionally, it is important to carefully insert the retractor along the acetabular margin without penetrating the joint capsule. Overall, this study provides valuable insights into the anatomical location and movement of the femoral and sciatic nerves in relation to hip motion and can help inform surgical techniques for safer THA.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Cadáver , Nervio Femoral , Articulación de la Cadera , Rango del Movimiento Articular , Nervio Ciático , Humanos , Nervio Ciático/anatomía & histología , Artroplastia de Reemplazo de Cadera/métodos , Nervio Femoral/anatomía & histología , Masculino , Femenino , Articulación de la Cadera/cirugía , Anciano , Traumatismos de los Nervios Periféricos/prevención & control , Traumatismos de los Nervios Periféricos/etiología , Anciano de 80 o más Años , Persona de Mediana Edad , Acetábulo/cirugíaRESUMEN
Peripheral nerve injuries in athletes affect the upper limb more commonly than the lower limb. Common mechanisms include compression, traction, laceration, and ischemia. Specific sports can have unique mechanisms of injury and are more likely to be associated with certain neuropathies. Familiarity with these sport-specific variables and recognition of the common presentations of upper limb neuropathic syndromes are important in assessing an athlete with a suspected peripheral nerve injury. Evaluation may require imaging modalities and/or electrodiagnostic testing to confirm a nerve injury. In some cases, diagnostic injections may be needed to differentiate neuropathic versus musculoskeletal etiology. Early and accurate diagnosis is essential for treatment/management and increases the likelihood of a safe return-to-sport and avoidance of long-term functional consequences. Most nerve injuries can be treated conservatively, however, severe or persistent cases may require surgical intervention. This monograph reviews key diagnostic, management, and preventative strategies for sports-related peripheral nerve injuries involving the upper limb.
Asunto(s)
Traumatismos en Atletas , Traumatismos de los Nervios Periféricos , Humanos , Traumatismos de los Nervios Periféricos/diagnóstico , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/terapia , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/diagnóstico por imagen , Extremidad Superior , AtletasRESUMEN
PURPOSE: This study aimed to investigate the incidence, risk factors of the sciatic nerve injury in patients with acetabulum fractures and assess its prognosis. METHODS: A retrospective cross-sectional review was conducted on 273 patients with acetabulum fractures who were treated between January 1st, 2017, and December 30th, 2019. The medical records and radiographs of these patients were analyzed. RESULTS: The overall nerve injury rate was 7.7% (21 of 273 cases), with 3.1% (8 of 273 cases) occurring because of the initial injury and 12.8% (13 of 101 cases) as post-operative complications. Among those with nerve injuries, 95.2% (20 of 21 cases) were males and the average age of the patients was 31.5 (SD 9.5) years. The most common mechanism of injury was motor vehicle collisions with 55.7% (152 of 273 cases), and the most common fracture pattern associated with nerve injury was posterior column and posterior wall fracture with 31.6% (6 of 21 cases). Hip dislocation was found in 16.5% (14 of 21 cases) of patients with nerve injury. The Kocher Langenbeck approach was the most common approach used for patients with post-operative nerve injury, and the prone position was significantly associated with sciatic nerve injury during the operation. Of all patients with nerve injury, 52% (11 of 21 cases) had fully recovered, 29% (6 of 21 cases) had partially recovered, and 19% (4 of 21 cases) had no improvement. The average follow-up was 15 months. CONCLUSION: This study emphasizes the incidence of sciatic nerve injuries in individuals with acetabulum fractures and highlights key risk factors, including hip dislocation, posterior column, and posterior wall fractures. It is noteworthy that the Kocher Langenbeck approach and the prone position may contribute to iatrogenic nerve injuries. Encouragingly, over half of the patients who suffered nerve injuries achieved full recovery, while nearly one-third experienced partial recovery. These findings underscore the vital significance of recognizing and addressing these risk factors in clinical practice.
Asunto(s)
Fracturas Óseas , Luxación de la Cadera , Fracturas de Cadera , Traumatismos de los Nervios Periféricos , Fracturas de la Columna Vertebral , Masculino , Humanos , Adulto , Femenino , Estudios Transversales , Estudios Retrospectivos , Luxación de la Cadera/cirugía , Incidencia , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Acetábulo/lesiones , Fijación Interna de Fracturas/efectos adversos , Fracturas de Cadera/cirugía , Fracturas Óseas/complicaciones , Fracturas Óseas/epidemiología , Fracturas Óseas/cirugía , Fracturas de la Columna Vertebral/complicaciones , Pronóstico , Factores de Riesgo , Traumatismos de los Nervios Periféricos/epidemiología , Traumatismos de los Nervios Periféricos/etiología , Nervio Ciático/lesionesRESUMEN
OBJECTIVE: Describe features of iatrogenic "overshoot" nerve injuries on ultrasound and MRI, which occur when an instrument passes through the bone and injures the nerve after it penetrates the opposite cortex. MATERIALS AND METHODS: After a keyword search of the radiology database at a tertiary care orthopedic hospital from January 2016 to December 2022, those fulfilling the inclusion criteria of (1) instrumentation through the bone during surgery, (2) acute neuropathy immediately after surgery, (3) nerve injury confirmed on electrodiagnostics, and (4) imaging consistent with overshoot nerve injury were included. Imaging studies were retrospectively evaluated to determine primary and secondary signs of an overshoot nerve injury. RESULTS: Six patients (3 females, mean age 26.7 (range 10-49) years) had nerve injury fitting the mechanism of injury: 3 injuries to the radial nerve during fixation of distal humerus fractures, 1 tibial nerve and 1 superficial peroneal nerve injury during fixation of tibial fractures, and 1 posterior interosseous nerve injury during biceps tendon repair. Ultrasounds were performed in all while 4 also had MRI. Secondary signs included (1) cortical defect adjacent to injured nerve (n=2); (2) scar extending from bone to injured nerve (n=2); (3) screw tip pointing to injured nerve (n=1, 4) tract in bone on MRI from previous instrumentation pointing to injured nerve (n=2). CONCLUSION: In addition to primary signs such as laceration or neuroma, secondary signs of "overshoot" nerve injury include cortical defect, scar extending to nerve, screw tip pointing to nerve, and linear tract in the bone on MRI.
Asunto(s)
Cicatriz , Traumatismos de los Nervios Periféricos , Femenino , Humanos , Niño , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Estudios Retrospectivos , Tendones , Traumatismos de los Nervios Periféricos/diagnóstico por imagen , Traumatismos de los Nervios Periféricos/etiología , Enfermedad IatrogénicaRESUMEN
Recently, a novel size-adjustable cryoballoon has been introduced in clinical practice, which can be inflated to two different diameters (28 and 31 mm). The 31 mm cryoballoon is specifically designed to achieve better contact with remodeled pulmonary veins (PVs) that have wider ostia while avoiding deep cannulation, thereby potentially reducing the risk of phrenic nerve injury (PNI) associated with deep balloon cannulation. However, we encountered two cases of PNI during cryoballoon ablation using the novel system among our initial 25 consecutive case series. Herein, we present two cases that exhibited PNI during freezing of the right superior PV with a size-adjustable balloon. While larger balloons are expected to create a larger area of isolation, the safety of this novel balloon system needs to be evaluated in a large-scale clinical study.