RESUMO
Introducción: Los objetivos de este estudio fueron determinar la incidencia de lesión iatrogénica intraquirúrgica del nervio radial durante la osteosíntesis de la diáfisis y el extremo distal del húmero, distinguir factores de riesgos asociados y reconocer elementos pronósticos que participan de su recuperación. Materiales y Métodos: Se evaluó, en forma retrospectiva, a 82 pacientes con osteosíntesis de húmero entre 2005 y 2021, sin parálisis radial preoperatoria. Se consideraron los sistemas de fijación utilizados, y se compararon las cirugías primarias con las reoperaciones y el tiempo transcurrido entre estas. El diagnóstico de parálisis radial posoperatorio fue clínico. Todos los pacientes fueron tratados con férula en extensión de muñeca, electroestimulación, kinesiología y vitaminas B1, B6, B12. La electromiografía se solicitó a los fines del pronóstico. Resultados: Nueve pacientes tuvieron déficit motor del nervio radial en el posoperatorio inmediato. El sistema de fijación era una placa (7 casos), sistema de cable-placa (1 caso) y clavo endomedular acerrojado anterógrado (1 caso). Siete ocurrieron en cirugías primarias y dos en reoperaciones. El 88% recuperó su función motora completamente antes de los 6 meses después de la parálisis. La electromiografía reveló un nervio radial no excitable en el 22% restante con parálisis definitiva. Conclusiones: El uso de placa de osteosíntesis, la disección intraoperatoria del nervio radial y las reoperaciones aumentan la incidencia de parálisis. Un nervio radial no excitable se relaciona con un peor pronóstico de recuperación espontánea. Nivel de Evidencia: IV
Introduction: The purpose of this study is to determine the incidence of intraoperative iatrogenic radial nerve injury after osteosynthesis of the diaphysis and distal end of the humerus, identify associated risk factors, and determine the prognostic factors involved in its recovery. Materials and Methods: We retrospectively assessed 82 humerus osteosynthesis cases between 2005 and 2021 who had normal radial nerve function before surgery. We evaluated the fixation systems used, the type of surgery (primary versus revision), and the intervals between surgeries. The diagnosis of postoperative radial palsy was made by clinical examination. All patients were treated with wrist extension splint, physiotherapy, and vitamins B1, B6, and B12. Results: After humerus fixation, 9 patients developed motor palsy. Seven cases were fixed with plates, one with a cable-plate system, and one with an anterograde locking intramedullary nail. Seven cases (22%) occurred after primary procedures, while two occurred during revisions. Within 6 months, 88% had regained full motor function. In the remaining 22% of patients with definite palsy, electromyography revealed no excitability of the radial nerve. Conclusions: The use of an osteosynthesis plate, as well as intraoperative dissection and neurolysis of the radial nerve, were identified as risk factors for the development of radial palsy. Reoperations on the humerus, on the other hand, are a risk factor that increases the likelihood of postoperative radial nerve palsy. A radial nerve with no excitability on the postoperative electromyogram has a poor prognosis of spontaneous radial nerve function recovery. Level of Evidence: IV
Assuntos
Braço , Nervo Radial/lesões , Fixação Interna de Fraturas , Fraturas do Úmero , Doença Iatrogênica , Complicações IntraoperatóriasRESUMO
INTRODUCTION: nerve lesions are potentially catastrophic injuries. They can cause motor loss, severe pain and neuroma formation. The superficial branch of the radial nerve is at risk during first dorsal compartment release, its injury can cause neuroma formation. Autologous nerve reconstruction is the gold standard for treatment of small nerve gaps. CASES PRESENTATION: we present two cases of adult women (F/47 y F/51) with a prior history of first dorsal compartment release in another institution. Both patients developed debilitating neuropathic pain, as well as allodynia in the surgical site. They were diagnosed with superficial radial nerve neuroma. Oral medication and physical therapy was attempted without success. Surgical exploration and autologous nerve reconstruction was performed. Both patients had excellent relief of pain from visual analogue scale (VAS 9-10 to VAS 1-2). Postoperatively, both patients recovered partial sensitivity to pain in the zones distal to the repair. CONCLUSIONS: neuromas are feared complications that occur with unrecognized nerve lesions during surgery, they are difficult to treat and require multidisciplinary management. These two cases demonstrate that autologous nerve reconstruction is an excellent option for recovering function in small gaps of nerve tissue.
INTRODUCCIÓN: las lesiones iatrogénicas de nervio son complicaciones devastadoras de cualquier procedimiento quirúrgico. Ocasionan pérdida motora, dolor y formación de neuromas. En el abordaje para la liberación del primer compartimiento extensor de la muñeca, la rama superficial del nervio radial debe identificarse y protegerse previo a la liberación tendinosa. La lesión de este nervio sensitivo puede ocasionar dolor postoperatorio clínicamente significativo. La reconstrucción nerviosa con nervio autólogo ha demostrado en diversos escenarios buenos resultados para mejorar el dolor y recuperar la conducción nerviosa. PRESENTACIÓN DE LOS CASOS: se presentan dos casos de mujeres adultas (F/47 y F/51) con antecedente de liberación de primer compartimiento dorsal de muñeca en otro centro hospitalario. Desarrollaron posteriormente dolor incapacitante y alodinia en sitio quirúrgico, así como limitación funcional. Fueron evaluadas y diagnosticadas como neuroma de rama superficial del nervio radial. No hubo mejoría con terapia física, por lo que se realizó reconstrucción nerviosa con injerto autólogo de nervio sural. Ambas pacientes tuvieron alivio del dolor de EVA 9-10 hasta EVA 1-2. A los cuatro meses de seguimiento, las dos mujeres recuperaron parcialmente la sensibilidad distal al sitio del neuroma, sin recurrencia del dolor presentado. CONCLUSIONES: los neuromas son complicaciones devastadoras que ocurren con lesiones inadvertidas de nervios motores y sensitivos. La reconstrucción con nervio autólogo es una excelente opción para reconstrucción de pequeños tramos de nervio periférico.
Assuntos
Neuroma , Procedimentos de Cirurgia Plástica , Adulto , Humanos , Feminino , Nervo Radial/lesões , Dor/etiologia , Neuroma/cirurgia , Neuroma/diagnóstico , Neuroma/etiologiaRESUMO
INTRODUCTION: Posterior interosseous nerve syndrome, a branch of the radial nerve at the level of the forearm, is characterized by the motor function loss of some or all of the muscles innervated distally. CLINICAL CASE: A 26-year-old male with a history of proximal radius fracture associated to radial nerve injury, treated with osteosynthesis 7 years earlier, with full recovery, who currently presented intense pain 4 cm distal to the radial head, accompanied by paralysis of Extensor pollicis longus, Extesnor pollicis brevis and Abductor pollicis longus, with paresis of the Extensor indicis propius, in which a diagnosis of entrapment syndrome of the anterior descending branch of the posterior interosseous nerve (SNIP) was performed. DISCUSSION: The conservative management of SNIP is indicated during the first 8-12 weeks, if no improvement is found, the indication for surgical exploration is indicated, and the removal of osteosynthesis material is controversial.
INTRODUCCIÓN: El síndrome del nervio interóseo posterior, rama del nervio radial a nivel del antebrazo se caracteriza por la pérdida de función motora de algunos o todos los músculos inervados distalmente. CASO CLÍNICO: Masculino de 26 años con antecedente de fractura de radio proximal manejado con osteosíntesis que cursó con lesión del nervio radial siete años antes con recuperación completa, acude con dolor intenso a 4 cm distal a cabeza radial, acompañado de parálisis del extensor largo y corto del pulgar y del abductor del pulgar, con paresia del extensor propio del índice, en el que se efectúa diagnóstico de síndrome de atrapamiento de la rama anterior descendente del nervio interóseo posterior (SNIP). DISCUSIÓN: El manejo conservador del SNIP está indicado durante las primeras ocho a 12 semanas, de no mostrar mejoría la indicación de exploración quirúrgica está indicada, siendo el retiro de material de osteosíntesis controvertido.
Assuntos
Articulação do Cotovelo , Antebraço , Nervo Radial , Fraturas do Rádio , Adulto , Humanos , Masculino , Músculo Esquelético , Nervo Radial/lesões , Nervo Radial/cirurgia , Rádio (Anatomia) , Fraturas do Rádio/complicaçõesRESUMO
Resumen: Introducción: El síndrome del nervio interóseo posterior, rama del nervio radial a nivel del antebrazo se caracteriza por la pérdida de función motora de algunos o todos los músculos inervados distalmente. Caso clínico: Masculino de 26 años con antecedente de fractura de radio proximal manejado con osteosíntesis que cursó con lesión del nervio radial siete años antes con recuperación completa, acude con dolor intenso a 4 cm distal a cabeza radial, acompañado de parálisis del extensor largo y corto del pulgar y del abductor del pulgar, con paresia del extensor propio del índice, en el que se efectúa diagnóstico de síndrome de atrapamiento de la rama anterior descendente del nervio interóseo posterior (SNIP). Discusión: El manejo conservador del SNIP está indicado durante las primeras ocho a 12 semanas, de no mostrar mejoría la indicación de exploración quirúrgica está indicada, siendo el retiro de material de osteosíntesis controvertido.
Abstract: Introduction: Posterior interosseous nerve syndrome, a branch of the radial nerve at the level of the forearm, is characterized by the motor function loss of some or all of the muscles innervated distally. Clinical case: A 26-year-old male with a history of proximal radius fracture associated to radial nerve injury, treated with osteosynthesis 7 years earlier, with full recovery, who currently presented intense pain 4 cm distal to the radial head, accompanied by paralysis of Extensor pollicis longus , Extesnor pollicis brevis and Abductor pollicis longus, with paresis of the Extensor indicis propius , in which a diagnosis of entrapment syndrome of the anterior descending branch of the posterior interosseous nerve (SNIP) was performed. Discussion: The conservative management of SNIP is indicated during the first 8-12 weeks, if no improvement is found, the indication for surgical exploration is indicated, and the removal of osteosynthesis material is controversial.
Assuntos
Humanos , Masculino , Adulto , Nervo Radial/cirurgia , Nervo Radial/lesões , Fraturas do Rádio/complicações , Articulação do Cotovelo , Antebraço , Rádio (Anatomia) , Músculo EsqueléticoRESUMO
PURPOSE: To report the results of radial nerve grafting in 7 children who sustained a radial nerve injury following a distal humeral fracture. METHODS: Seven children, mean age 6 years (range, 4-11 years), underwent nerve grafting for radial nerve injuries following distal humeral fractures. The mean interval between injury and surgery was 6.7 months (range, 6-9 months). In all cases, 3 sural nerve graft cables were used, of mean length 8.6 cm (range, 6-12 cm). Mean follow-up was 19.9 months (range, 12-24 months). Wrist, finger, and thumb extension range of motion and strength were evaluated at final follow-up, using the British Medical Research Council (BMRC) rating scale. RESULTS: The radial nerve was entrapped within the fracture site in 2 patients, and in 5, it was completely interrupted without entrapment. All patients obtained full active wrist extension with grade M4 BMRC strength. For finger extension, all patients were graded as M4, obtaining full metacarpophalangeal finger and thumb extension, with the wrist in neutral in 3 patients and fully extended in 4. During the thumbs-up test, 4 patients achieved complete extension of all thumb joints, and 3 exhibited metacarpophalangeal extension lag, averaging 30°. CONCLUSIONS: Nerve grafting of radial nerve injuries at the level of the distal humerus in children can yield excellent outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
Assuntos
Fraturas do Úmero/cirurgia , Nervo Radial/lesões , Nervo Radial/cirurgia , Nervo Sural/transplante , Criança , Pré-Escolar , Feminino , Seguimentos , Força da Mão , Humanos , Masculino , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos RetrospectivosRESUMO
BACKGROUND: The aim of our study was to objectively test sensibility on the dorsal side of the hand in patients with radial nerve injury, to document deficits and to detect if surgery for sensory reconstruction is needed. METHODS: Nineteen patients of mean age 31 ± 10 years were examined at a mean of 26.4 ± 27.8 months post radial nerve injury. Sensory mechanical thresholds on the dorsal surface of the hand were evaluated using Semmes-Weinstein monofilaments. Sensation was considered significantly impaired when there was no perception of a 2.0 gr. Semmes-Weinstein filament. Nociception was evaluated using Adson forceps. RESULTS: Five patients had normal 2.0 monofilament perception. Two of these five also had normal perception of the lighter 0.05 monofilament. In nine patients, zones of impaired sensibility were restricted to the first web space. In combined radial and musculocutaneous nerve lesions, the zone of impaired sensibility extended to the dorsum of the third metacarpus and occasionally to the dorsal aspect of the thumb. This zone averaged being five times the size as in isolated radial nerve injuries. On average, the zone of decreased 0.05 monofilament perception was six times the size detected for the 2.0 monofilament. No patient had complete anesthesia over the dorsum of the hand. No patient complained about pain or numbness. Only one patient among four with a combined radial and musculocutaneous nerve injury required sensory reconstruction. CONCLUSIONS: Minimal sensory abnormalities should be expected after a radial nerve injury. Patients likely neither warrant nor request sensory reconstruction.
Assuntos
Mãos/inervação , Regeneração Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/complicações , Nervo Radial/lesões , Transtornos de Sensação/fisiopatologia , Adolescente , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/terapia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Transtornos de Sensação/etiologia , Limiar Sensorial/fisiologia , Adulto JovemRESUMO
PURPOSE: The purpose of this article is to explore the real-life practice of clinical management of humeral shaft fracture associated with traumatic radial nerve palsy among orthopedic trauma surgeons. METHODS: Two hundred seventy-nine orthopedic surgeons worldwide reviewed 10 real cases of a humeral shaft fracture associated with traumatic radial nerve palsy answering two questions: (1) What treatment would you choose/recommend: nonoperative or operative? (2) What are the reasons for your decision-making? The survey was developed in an online survey tool. All participants were active members from AOTrauma International. RESULTS: Two hundred sixty-six (95.3%) participants were from Latin America and Asia/Pacific. One hundred sixty-two participants (58.1%) had more than 10 years in practice and 178 (63.8%) of them did trauma as the main area of interest. One hundred fifty-one (54.1%) participants treated less than three humeral shaft fractures a month. Traumatic radial nerve palsy was the main reason (88.4%) for surgeons to recommend surgical treatment. Open reduction and internal fixation (ORIF) or percutaneous fixation of the fracture associated with acutely explore of radial nerve was the first option in 62.0% of the cases. A combination of morphology and level of the fracture and the presence of the radial nerve palsy was the most suggested reason to surgically treat the humerus fracture. The main isolated factor was the morphology of the fracture. CONCLUSION: Our survey highlight the tendency for a more aggressive management of any humeral shaft fracture associated with a traumatic radial nerve palsy, with surgeons preferring to use ORIF with acute exploration of the radial nerve. Nonsurgical management was the less chosen option among the 279 respondents. Fracture morphology, level of the fracture, and the presence of the radial nerve palsy were most influential for guiding their treatment.
Assuntos
Fraturas do Úmero/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Nervo Radial/lesões , Neuropatia Radial/epidemiologia , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Adulto , Idoso , Ásia/epidemiologia , Feminino , Humanos , Fraturas do Úmero/cirurgia , Incidência , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Neuropatia Radial/etiologia , Adulto JovemRESUMO
OBJECTIVE Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years and the average time between accident and surgery was 6 months. Sural nerve graft length averaged 12 cm. Recovery was scored according to the British Medical Research Council (BMRC) scale, which ranges from M0 to M5 (normal muscle strength). RESULTS After grafting, all 7 patients with an elbow extension palsy recovered elbow extension, scoring M4. Six of the 13 recovered M4 wrist extension, 6 had M3, and 1 had M2. Thumb and finger extension was scored M4 in 3 patients, M3 in 2, M2 in 2, and M0 in 6. CONCLUSIONS The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good results. Based on these criteria, overall good results were obtained in only 5 of the 13 patients. In proximal radial nerve lesions, the authors now advocate combining nerve grafts with nerve or tendon transfers to reconstruct wrist, thumb, and finger extension.
Assuntos
Cotovelo/fisiopatologia , Mãos/fisiopatologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Traumatismos dos Nervos Periféricos/cirurgia , Nervo Radial/lesões , Nervo Sural/transplante , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Úmero , Masculino , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento , Adulto JovemRESUMO
OBJECT Results of radial nerve grafting are largely unknown for lesions of the radial nerve that occur proximal to the humerus, including those within the posterior cord. METHODS The authors describe 13 patients with proximal radial nerve injuries who were surgically treated and then followed for at least 24 months. The patients' average age was 26 years and the average time between accident and surgery was 6 months. Sural nerve graft length averaged 12 cm. Recovery was scored according to the British Medical Research Council (BMRC) scale, which ranges from M0 to M5 (normal muscle strength). RESULTS After grafting, all 7 patients with an elbow extension palsy recovered elbow extension, scoring M4. Six of the 13 recovered M4 wrist extension, 6 had M3, and 1 had M2. Thumb and finger extension was scored M4 in 3 patients, M3 in 2, M2 in 2, and M0 in 6. CONCLUSIONS The authors consider levels of strength of M4 for elbow and wrist extension and M3 for thumb and finger extension to be good results. Based on these criteria, overall good results were obtained in only 5 of the 13 patients. In proximal radial nerve lesions, the authors now advocate combining nerve grafts with nerve or tendon transfers to reconstruct wrist, thumb, and finger extension.
Assuntos
Úmero/lesões , Transferência de Nervo/métodos , Procedimentos Neurocirúrgicos/métodos , Nervo Radial/lesões , Nervo Radial/cirurgia , Adolescente , Adulto , Cotovelo/cirurgia , Humanos , Fixadores Internos , Masculino , Motocicletas , Força Muscular , Procedimentos de Cirurgia Plástica , Nervo Sural/cirurgia , Polegar/fisiologia , Resultado do Tratamento , Punho/fisiologia , Adulto JovemRESUMO
Objective: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital. Methods: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out. Results: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively. Conclusion: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study.
Assuntos
Humanos , Masculino , Feminino , Nervo Radial/lesões , Acidentes de Trânsito , Epidemiologia Descritiva , Fraturas do ÚmeroRESUMO
Surgeons believe that in high ulnar nerve lesion distal interphalangeal joint (DIP) flexion of the ring and little finger is abolished. In this article, we present the results of a study on innervation of the flexor digitorum profundus of the ring and little fingers in five patients with high ulnar nerve injury and in 19 patients with a brachial plexus, posterior cord, or radial nerve injury. Patients with ulnar nerve lesion were assessed clinically and during surgery for ulnar nerve repair we confirmed complete lesion of the ulnar nerve in all cases. In the remaining 19 patients, during surgery, either the median nerve (MN) or the anterior interosseous nerve (AIN) was stimulated electrically and DIP flexion of the ring and little fingers evaluated. All patients with high ulnar nerve lesions had active DIP flexion of the ring and little fingers. Strength scored M4 in the ring and M3-M4 in the little finger. Electrical stimulation of either the MN or AIN produced DIP flexion of the ring and little fingers. Contrary to common knowledge, we identified preserved flexion of the distal phalanx of the ring and little fingers in high ulnar nerve lesions. On the basis of these observations, nerve transfers to the AIN may provide flexion of all fingers.
Assuntos
Traumatismos dos Dedos/fisiopatologia , Articulações dos Dedos/fisiologia , Nervo Mediano/fisiologia , Transferência de Nervo , Traumatismos dos Nervos Periféricos/fisiopatologia , Procedimentos de Cirurgia Plástica/métodos , Amplitude de Movimento Articular/fisiologia , Adulto , Plexo Braquial/lesões , Plexo Braquial/fisiologia , Plexo Braquial/cirurgia , Eletrodiagnóstico , Traumatismos dos Dedos/cirurgia , Humanos , Traumatismos dos Nervos Periféricos/cirurgia , Nervo Radial/lesões , Nervo Radial/fisiologia , Nervo Radial/cirurgia , Resultado do Tratamento , Nervo Ulnar/lesões , Nervo Ulnar/fisiologia , Nervo Ulnar/cirurgiaRESUMO
OBJECTIVE: To determine whether the type of posterior surgical approach for distal humeral fracture open reduction and internal fixation influenced radial nerve strain during simulated operative retraction in a cadaveric model. METHODS: Three different posterior surgical exposures: triceps splitting, lateral paratricipital, and paratricipital with release of the lateral intermuscular septum were used. Radial nerve strain was measured using a microDVRT, while traction was applied with a digital force gauge at forces 0.1-0.3 kg. RESULTS: The lateral paratricipital with nerve decompression was superior to both the triceps splitting approach (P < 0.048) and paratricipital method without decompression (P < 0.036). There was no significant difference between the triceps splitting method and paratricipital exposure without intermuscular septum release. CONCLUSIONS: Radial nerve decompression through release of the lateral intermuscular septum through a lateral paratricipital exposure ideally decreases nerve strain during humeral open reduction and internal fixation in our cadaveric model.
Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Radial/lesões , Nervo Radial/cirurgia , Idoso , Descompressão Cirúrgica , Articulação do Cotovelo/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Traumatismos dos Nervos Periféricos/etiologiaRESUMO
OBJECT: Recent advancements in operative treatment of the brachial plexus authorized more extensive repairs and, currently, elbow extension can be included in the rank of desirable functions to be restored. This study aims to describe the author's experience in using the medial pectoral nerve for reinnervation of the triceps brachii in patients sustaining C5-7 palsies of the brachial plexus. METHODS: This is a retrospective study of the outcomes regarding recovery of elbow extension in 12 patients who underwent transfer of the medial pectoral nerve to the radial nerve or to the branch of the long head of the triceps. RESULTS: The radial nerve was targeted in 3 patients, and the branch to the long head of the triceps was targeted in 9. Grafts were used in 6 patients. Outcomes assessed as Medical Research Council Grades M4 and M3 for elbow extension were noted in 7 (58%) and 5 (42%) patients, respectively. CONCLUSIONS: The medial pectoral nerve is a reliable donor for elbow extension recovery in patients who have sustained C5-7 nerve root injuries.
Assuntos
Plexo Braquial/lesões , Plexo Braquial/cirurgia , Articulação do Cotovelo/inervação , Transferência de Nervo , Nervos Torácicos/transplante , Adulto , Braquetes , Vértebras Cervicais , Cotovelo/inervação , Eletromiografia , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular , Transferência de Nervo/métodos , Condução Nervosa , Nervo Radial/lesões , Nervo Radial/fisiopatologia , Nervo Radial/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Introdução: As lesões traumáticas do nervo radial podem ocasionar a disfunção de membros superiores devido à incapacidade de extensão do cotovelo, punho, mão e dedos, cujo resultado depende da gravidade da lesão, técnica cirúrgica, causa do trauma e tempo de cirurgia. Método: Apresentamos os resultados de 18 indivíduos submetidos ao tratamento tardio das lesões do nervo radial, realizado no período de 2001 a 2007, com o tempo de lesão menor que 15 meses e submetidos a reparação neural. Resultados: A média do tempo de seguimento foi de 48 meses. A recuperação motora satisfatória foi obtida em 90% dos casos submetidos à cirurgia. A recuperação funcional ocorreu em todos os casos submetidos à cirurgia, seja por epineurólise, neurorrafia epineural primária e, em um caso de insucesso, foi obtida a recuperação funcional com a transferência de tendão.
Introduction: Traumatic injuries of radial nerve lead to a dysfunction of upper extremities caused by elbow and wrist extension and finger grip inabilities, which depend on injury severity, surgical technique and trauma surgery time span. Methods: We present results from 18 subjects with late treatment of radial nerve injuries submitted to surgery during the period from 2001 to 2007, with injury time before then 15 months and submitted to neural repair. Results: The average follow up time is 48 month. A satisfactory motor repair was obtained in 90% of cases submitted to surgery. Functional recovery accessed in all cases submitted to surgery, either by epineurolysis, primary epineural repair and one case was obtained functional recovery with a tendon transfer.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Nervo Radial/lesões , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Operatórios , Transferência Tendinosa , Extremidade Superior , Métodos , Microscopia Eletrônica , Pacientes , MétodosRESUMO
BACKGROUND: The increased number of high energy accidents has led to the occurrence of several injuries in a single extremity, particularly among youths. Stanitski and Micheli defined the floating elbow as a forearm fracture plus an ipsilateral supracondylar fracture. Its incidence ranges from 3% to 13%, predominant ages are 7 to 11 years, with a 2:2 male:female ratio. The mechanism of injury is as follows: fall from a height with elbow hyperextension and wrist dorsiflexion and pronation of the forearm. OBJECTIVE: To present the case of a child with a type V left open floating elbow injury, severe soft tissue injury and median and radial nerve injury. CLINICAL CASE: A 12-year-old male weighing 70 kg and a height of 170 cm fell from a height of around 50 cm while riding on a skateboard and sustained a type V floating elbow injury. He was managed with a double antibiotic regimen, decontaminating wound care and fracture stabilization with a minimally invasive approach, using crossed Kirschner nails in the elbow, and centromedullary and retrograde nails in the radius and ulna. He underwent early rehabilitation. The patient resumed his usual activities at month 3 and was assessed using the DASH scale. The nerve injury was classified as neurapraxia. RESULTS: The skin healed at ten days. Passive motion of the elbow and wrist was started at week 2. Bone healing of the radio-ulna occurred at 35 days and of the humerus at 30 days. The nerve injury evolved properly without leaving any sensory or motor sequelae. According to the DASH Scale, the functional course was appropriate; the patient resumed his usual activities at month 3. No infection or compartmental syndrome occurred. CONCLUSIONS: The early and thorough washing of these injuries is an important factor to decrease the risk of infection. The minimally invasive approach is perfect to treat these injuries in children; it is less aggressive and preserves the integrity of soft tissues. Early rehabilitation and the prompt management of the nerve injury are fundamental to the functional result. The DASH Scale identifies the functional course, is easy to use and convenient for the patient.
Assuntos
Lesões no Cotovelo , Articulação do Cotovelo/cirurgia , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Traumatismo Múltiplo/cirurgia , Nervo Radial/lesões , Nervo Radial/cirurgia , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Criança , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Ortopédicos/métodosRESUMO
OBJECTIVE: To assess the functional results of nerve reconstruction with autologous interfascicular nerve grafts in a thoracic limb. MATERIAL AND METHODS: From January 1999 to December 2006. Complete nerve injuries of the radial, median and ulnar nerves. Follow-up was at least 12 months. VARIABLES: age, nerve defect length, location, interval between the injury and the treatment, mechanism, injuries, and adjunctive treatments. The procedures were performed by the authors. Nine and 10-0 sutures were used. The Medical Research Council System (MRCS) scale was used for the functional measurement. The chi2 test was applied to variables and functional results. RESULTS: 43 patients, 48 nerves, mean age 26.7 years; 29 males and 14 females. Nineteen injuries occurred in the ulnar nerve (39.5%), 18 in the median nerve (37.5%) and 11 in the radial nerve (23%). Five patients had injury of the median and ulnar nerves. Twenty three injuries involved the wrist (53.4%), 7 the forearm (16.2%) and 12 the arm (27.9%). The mean time elapsed between the injury and the treatment was 42.09 days. The mean size of the nerve defect was 4.4 cm. The mean followup was 17.5 months. Forty two patients had associated injuries and 37 received adjunctive treatment. Motor function: Results were good in 15 patients (31.2%), fair in 21 (43.8%), poor in 10 (20.8%) and bad in 2 (4.2%). Sensory function: Results were good in 36 nerves (75%), fair in 4 (83%), poor in 6 (12.5%) and bad in 2 (4.2%). DISCUSSION: The results were similar to those reported in the literature. CONCLUSIONS: Good results were obtained in gaps < or = 5 cm, in cases without arterial injury and when the time to treatment did not exceed 40 days (p < 0.05). The age, the nerve and the site of injury were not influencing factors.
Assuntos
Braço/inervação , Braço/cirurgia , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Nervos Periféricos/transplante , Nervo Radial/lesões , Nervo Radial/cirurgia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Adulto JovemRESUMO
OBJETIVO: elaborar um questionário de avaliação funcional para analisar as dificuldades manuais encontradas na realização de atividades cotidianas de indivíduos ocidentais adultos com lesão dos nervos ulnar, mediano ou radial.MÉTODO: foi realizada entrevista com 50 pessoas, idade entre 21 e 65 anos, portadoras de lesão nos nervos ulnar, mediano ou radial para identificar as dificuldades manuais ao realizar as tarefas cotidianas. Em seguida, seis cirurgiões de mão e nove terapeutas de mão, analisaram as tarefas listadas pelos entrevistados e as classificaram em níveis de importância para uma avaliação funcional das mãos. Posteriormente, o questionário foi elaborado baseado nessa classificação.RESULTADOS: o "Questionário de avaliação da mão com lesão de nervo" é constituído por 30 questões objetivas divididas em domínios de tarefas (vestuário, alimentação, higiene pessoal, tarefas domésticas, escrita, uso de computador e atividades diversas). As respostas são atribuídas de acordo com o grau de dificuldade na realização das tarefas listadas no instrumento. O questionário foi respondido por 32 pessoas com idade entre 18 e 65 anos apresentando sequela de hanseníase. O cálculo do alfa de Cronbach foi utilizado para avaliar a confiabilidade do instrumento. Após a remoção de duas questões relacionadas ao uso de computador, o resultado do alfa de Cronbach aumentou para 0,90.CONCLUSÃO: o "Questionário de avaliação da mão com lesão de nervo" apresenta alta consistência interna. Além disso, é conciso, de fácil preenchimento não necessitando a presença de profissional especializado para sua aplicação e permite a verificação do nível de independência do indivíduo com lesão de nervo periférico na mão na realização de suas tarefas habituais.
OBJECTIVE: to develop a functional evaluation questionnaire to limitations in hand function by western adults individuals with lesions of the ulnar, median or radial nerves in their routine tasks.DESIGN: an interview was conducted with 50 patients of 21-65 years of age with ulnar, median and radial nerve lesions to identify any manual difficulties in their performance of routine daily tasks. Six hand surgeons and nine hand therapists then analyzed the tasks listed by the patients and graded them in levels of importance for the evaluation of hand function, after which a questionnaire based on this classification was drawn up.RESULTS: the instrument Evaluation of Hand with Nerve Damage Questionnaire, consists of 30 objective questions divided into task domains (dressing, feeding, personal hygiene, housework, writing, use of computers and "others"), answers being classified according to degree of difficulty. The questionnaire was completed by 32 patients of 18-65 years of age with sequelae of Hansen's disease. Cronbach's coefficient alpha was used to assess the reliability of the instrument. Following removal of two questions regarding computer use, Cronbach's coefficient alpha increased to 0.90.CONCLUSION: the Evaluation of Hand with Nerve Damage Questionnaire shows a high internal consistency. In addition it is concise, easy to fill instrument not requiring specialized professional to apply and allows evaluation of the degree of independence of the individual with peripheral nerve lesion in the hand in performing routine daily tasks.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto Jovem , Centros de Reabilitação , Hanseníase/reabilitação , Inquéritos e Questionários , Nervo Mediano/lesões , Nervo Radial/lesões , Nervo Ulnar/lesões , Serviços de Reabilitação , Traumatismos dos Nervos PeriféricosRESUMO
In the last few years there has been great interest in minimally invasive plate osteosynthesis (MIPO) in the treatment of humeral shaft fractures. None of these studies showed the anatomical relationship between the radial nerve and the material of the implant in vivo. We performed postoperative ultrasonographic measurement of the distance between the radial nerve and the material implanted using the MIPO technique. Nineteen patients underwent postoperative ultrasound examinations. Group A comprised midshaft fractures and group B distal third fractures. The point of greatest proximity between the radial nerve and the implant was measured. In group A the distance was between 1.6 and 19.6 mm (mean: 9.3 mm) and in group B between 1.0 and 8.1 mm (mean: 4.0 mm). The ultrasound findings reveal that the radial nerve is quite close to the implant material, especially in the transition between the third and fourth quarters of the humeral shaft.
Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Período Pós-Operatório , Adulto , Idoso , Placas Ósseas/efeitos adversos , Feminino , Fixação Interna de Fraturas/métodos , Humanos , Fixadores Internos/efeitos adversos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nervo Radial/diagnóstico por imagem , Nervo Radial/lesões , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , UltrassonografiaRESUMO
MATERIAL AND METHODS: We conducted this study in the thoracic extremity surgery module, from the Trauma and Orthopedic Surgery Hospital "Lomas Verdes" of the Instituto Mexicano del Seguro Social (IMSS) from September 2001 to 2004. Eighty-seven patients were included with ages between 16 to 81 years, with the diagnosis of humeral shaft fracture without previous neurologic lesion and were treated with intramedullary nail or dynamic compression plate (DCP) with a 2 year follow up. RESULTS: Eighty seven patients were evaluated; mean age 42.2 +/- 3.2 years; male gender (61%) vs. female gender (39%) (p<0.05); more frequently affected extremity: left (59.7) vs. right (40.3%); acute period fracture: 59.7%; non union 25.3% and delay of consolidation: 15%. Implant used: DCP plate (80%) vs. intramedullary nailing (20%) (p<0.05%). Radial nerve lesion at the beginning and end of the study: 15 (22%) of 70 patients vs. 1 (5.5%) of 17 patients operated with DCP plate vs. intramedullary nail respectively. Of the 16 radial nerve lesions on total (100%), 12 presented with neuroapraxia (10.4%) that included a patient treated with intramedullary nailing and 4 (3.4%) axonotmesis treated with open reduction and internal fixation with DCP. CONCLUSION: The preference of treatment on our hospital is the use of DCP in humeral shaft fractures. The surgical technique with DCP represents a higher incidence of radial nerve lesion probably due to the exposure and proximity to the radial nerve during surgery. It will be necessary to verify these results in a clinical controlled trial.