Journal of Brachial Plexus and Peripheral Nerve Injury最新文献

{"title":"Surgical Treatment of Obstetric Plexus Lesions by Direct Coaptation Compared to Sural Nerve Graft Interposition.","authors":"Justus Mai, Christa Kunigunde Raak, Thomas Ostermann, Jörg Bahm, Wolfram Scharbrodt","doi":"10.1055/s-0044-1801398","DOIUrl":"https://doi.org/10.1055/s-0044-1801398","url":null,"abstract":"<p><p><b>Background</b>  To date, there are no uniform guidelines for the treatment of obstetric plexus lesions in German-speaking countries. An end-to-end direct suture after resection of trunk neuroma is recommended for surgical treatment if tension-free coaptation is possible, whereas the use of autologous nerve grafts bridging the gap between the adaptation margins is advised by consensus if tension-free coaptation is impossible. <b>Objective</b>  The aim of the study was to investigate which reconstruction strategy may provide a better recovery of motor function for patients after obstetric brachial plexus lesion. <b>Methods</b>  This study compared postoperative functional outcome after obstetric brachial plexus palsy from a patient collective including a total of 43 children. The surgical techniques of plexus reconstruction by end-to-end coaptation versus the use of sural nerve interposition graft have been analyzed. Therefore, the degrees of active motion of abduction and external rotation in the shoulder joint, and flexion in the elbow joint were assessed using the neutral zero method. <b>Results</b>  For abduction in the shoulder joint, significantly better motor function was found in the group with direct sutures ( <i>p</i>  = 0.033). For external rotation in the shoulder joint and flexion in the elbow joint, there was no statistically significant difference between the groups ( <i>p</i>  = 0.284 and <i>p</i>  = 0.270, respectively). <b>Conclusions</b>  This study could not demonstrate absolute superiority of either reconstruction method. Slight evidence was found for a better functional outcome for plexus reconstruction by direct coaptation. Further arguments support a better suitability of plexus reconstruction by direct suture if its use is justifiable.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e9-e15"},"PeriodicalIF":1.1,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11735068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tendon Transfer Procedures for Correction of Foot Drop Due to Injury to the Peripheral Nerves or Muscles.","authors":"Henrik Lauer, Johannes Christoph Heinzel, Benedetta Vasselli, Farhad Farzaliyev, Jana Ritter, Jonas Kolbenschlag, Adrien Daigeler, Cosima Prahm","doi":"10.1055/s-0044-1801322","DOIUrl":"10.1055/s-0044-1801322","url":null,"abstract":"<p><p><b>Background</b>  Foot drop is a challenging condition that significantly impacts the affected patient's mobility and quality of life. Tendon transfer has emerged as a viable treatment option. We hereby present data of the tendon transfer procedures in patients with foot drop in our department. Besides a detailed description of our surgical technique, we also compare our results with those reported in the literature. <b>Methods</b>  Data from 17 patients (11 males and 6 females) suffering from foot drop due to peripheral nerve or muscle lesions were retrospectively analyzed. All the patients underwent tendon transfer procedures between 2017 and 2022. Assessed outcomes encompassed parameters such as strength of foot dorsiflexion, the necessity for postoperative orthotic devices, and patient satisfaction. Demographic data, the time elapsed from injury/illness to surgery, and the underlying causes of foot drop were collected. <b>Results</b>  Postsurgery, 14 patients regained robust dorsiflexion strength (M4), while 2 exhibited slightly lower strength (M3) and 1 attained equal strength as on the unaffected side (M5). Corrective procedures were undertaken in five patients to address problems with tendon tension. After an average follow-up period of 11.9 months (± 9.13), 82.4% of patients reported a high level of satisfaction, although three patients experienced persistent foot inversion. Most patients (94.1%) no longer required orthotic devices following the operative procedure. <b>Conclusion</b>  A tendon transfer procedure for correction of foot drop has proven to be a safe and effective treatment option, resulting in a high level of patient satisfaction and restoration of quality of life.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"20 1","pages":"e1-e8"},"PeriodicalIF":1.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11723794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Changes Following Carpal Tunnel Syndrome Treated with Guided Plasticity: A Prospective, Randomized, Placebo-Controlled Study.","authors":"Magnus Flondell, Peter Mannfolk, Birgitta Rosén, Isabella M Björkman-Burtscher, Anders Björkman","doi":"10.1055/s-0044-1792169","DOIUrl":"10.1055/s-0044-1792169","url":null,"abstract":"<p><p><b>Background</b>  Compression neuropathy, such as carpal tunnel syndrome (CTS), results in changed afferent nerve signaling, which may result in changes in somatosensory brain areas. The purpose of this study was to assess cerebral changes following unilateral CTS and to assess short-term and long-term cerebral effects of guided plasticity treatment using ipsilateral cutaneous forearm deafferentation. <b>Methods</b>  Twenty-four patients with mild-to-moderate unilateral CTS were randomized to treatment with anesthetic cream (EMLA) or placebo. Patient-rated outcomes were assessed using Boston CTS questionnaire and disability of arm, shoulder, and hand questionnaire (QuickDASH). Patients were assessed for tactile discrimination and dexterity. Cortical activation during sensory stimulation was evaluated with functional magnetic resonance imaging at 3T. Assessments were performed at baseline, 90 minutes, and 8 weeks after treatment. <b>Results</b>  Functional magnetic resonance imaging showed that sensory stimulation of the hand with CTS resulted in significantly less cortical activation in the primary somatosensory cortex (S1) than stimulation of the healthy hand. Treatment with cutaneous forearm deafferentation on the side with CTS resulted in increased cortical activation in S1 both after the initial treatment and following 8 weeks of treatment. In addition, QuickDASH and tactile discrimination showed improvement in the EMLA group over time. <b>Conclusions</b>  Stimulation of median nerve-innervated fingers in patients with unilateral CTS results in smaller-than-normal activation in the contralateral S1. Cutaneous forearm anesthesia on the side with CTS results in larger activation in S1, suggesting recruitment of more neurons, and a slight improvement in sensory function.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"19 1","pages":"e31-e41"},"PeriodicalIF":1.1,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11563718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Hand and Shoulder Function in Children following Early Surgical Intervention for a Birth-Related Upper Brachial Plexus Injury.","authors":"Rachel N Aber, Leslie A Grossman, Aaron J Berger, Andrew E Price, Israel Alfonso, John A I Grossman","doi":"10.1055/s-0044-1787151","DOIUrl":"10.1055/s-0044-1787151","url":null,"abstract":"<p><p><b>Purpose</b>  To better understand the long-term hand and shoulder outcomes of upper brachial plexus birth injuries. <b>Methods</b>  We evaluated shoulder and hand function in 32 patients (13 males; 19 females) with a C5/C6 birth injury history). All patients had undergone primary nerve surgery as infants, and 12 underwent a simultaneous shoulder procedure as they presented with a fixed internal rotation contracture of the shoulder. On average, all patients were evaluated and examined 15 years postoperatively. The shoulder function was evaluated using the Miami Shoulder Scale. Hand function was measured by the 9-hole peg test (9-HPT) and statistical analysis included comparison of 9-HPT time against normative data using the Student's <i>t</i> -test. <b>Results</b>  The cohort includes 22 right-hand-dominant and 10 left-hand-dominant patients. Mean age at surgery was 10 months; mean age at follow-up was 15 years ± 2 years 2 months. Cumulative shoulder function was \"good\" or \"excellent\" (Miami score) in 23 patients. For 9-HPT, 23 out of 32 patients seen had an involved hand with a significant alteration in function. <b>Conclusion</b>  Early nerve surgery in cases of upper brachial plexus birth injuries result in the desired outcome. To ensure timely and targeted therapy for any residual deficits, it is imperative that limitations in hand function among children with an Erb's palsy.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"19 1","pages":"e27-e30"},"PeriodicalIF":1.1,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11192585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of COVID-19 Pandemic in Patients with a Previous Phrenic Nerve Transfer for a Traumatic Brachial Plexus Palsy.","authors":"Mariano Socolovsky, Johnny Chuieng-Yi Lu, Francisco Zarra, Chen Kuan Wei, Tommy Nai-Jen Chang, David Chwei-Chin Chuang","doi":"10.1055/s-0044-1787296","DOIUrl":"10.1055/s-0044-1787296","url":null,"abstract":"<p><p><b>Background</b>  With the advent of the coronavirus disease 2019 (COVID-19) pandemic, some doubts have been raised regarding the potential respiratory problems that patients who previously underwent a phrenic nerve transfer could have. <b>Objectives</b>  To analyze the effects of the coronavirus infection on two populations, one from Argentina and another from Taiwan. Specific objectives were: (1) to identify the rate of COVID in patients with a history of phrenic nerve transfer for treatment of palsy; (2) to identify the overall symptom profile; (3) to compare Argentinian versus Taiwanese populations; and (4) to determine if any phrenic nerve transfer patients are at particular risk of more severe COVID. <b>Methods</b>  A telephonic survey that included data regarding the number of episodes of acute COVID-19 infection, the symptoms it caused, the presence or absence of potential or life-threatening complications, and the status of COVID-19 vaccination were studied. Intergroup comparisons were conducted using the nonparametric Mann-Whitney U test, with categorical variables conducted using either the Pearson χ2 analysis or the Fisher's exact test, as appropriate. <b>Results</b>  A total of 77 patients completed the survey, 40 from Taiwan and 37 from Argentina. Fifty-five (71.4%) developed a diagnosis of COVID. However, among these, only four had any level of dyspnea reported (4/55 = 7.3%), all mild. There were also no admissions to hospital or an intensive care unit, no intubations, and no deaths. All 55 patients isolated themselves at home. <b>Conclusions</b>  It can be concluded that an acute COVID-19 infection was very well tolerated in our patients. (Level of evidence 3b, case reports).</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"19 1","pages":"e20-e26"},"PeriodicalIF":0.7,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11168810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Results of Isolated Latissimus Dorsi to Rotator Cuff Transfer in Brachial Plexus Birth Injury.","authors":"David J Kirby, Daniel B Buchalter, Lauren Santiesteban, Mekka R Garcia, Aaron Berger, Jacques Hacquebord, John A I Grossman, Andrew E Price","doi":"10.1055/s-0044-1786817","DOIUrl":"10.1055/s-0044-1786817","url":null,"abstract":"<p><p><b>Background</b>  Brachial plexus birth injury results in deficits in strength and motion, occasionally requiring surgery to restore power to the deficient external rotators of the shoulder in these patients. This is a retrospective analysis of the long-term results of an isolated latissimus dorsi transfer to the rotator cuff in patients with brachial plexus birth injury. <b>Methods</b>  This is a retrospective review of prospectively collected data for patients undergoing isolated latissimus dorsi transfer into the infraspinatus in addition to release of the internal rotation contracture of the shoulder with greater than 5 years' follow-up. Preoperative and postoperative shoulder elevation and external rotation were documented. Failure of surgery was defined as a return of the internal rotation contracture and a clinically apparent clarion sign. <b>Results</b>  A total of 22 patients satisfied the inclusion criteria: 9 global palsies and 13 upper trunk palsies. The average follow-up was 11 years, ranging from 7.5 to 15.9 years. There was a trend for improved external rotation in the global palsy cohort at final follow-up ( <i>p</i>  = 0.084). All nine global palsies maintained adequate external rotation without a clarion sign. Five of the 13 upper trunk palsies failed the latissimus dorsi transfer and subsequently required either teres major transfer and/or rotational osteotomy. In these five failures, the period from initial transfer to failure averaged 6.6 years, ranging from 3.4 to 9.5 years. <b>Conclusion</b>  The results of this study indicate that patients with global palsy have sustained long-term improved outcomes with isolated latissimus dorsi transfer while patients with upper trunk palsy have a high rate of failure. Based on these results, we recommend isolated latissimus dorsi transfer for global palsy patients who have isolated infraspinatus weakness. <b>Level of Evidence:</b>  Case series - Level IV.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"19 1","pages":"e13-e19"},"PeriodicalIF":0.7,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11168807/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141310801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining the Inclusion Criteria for Successful Steindler Flexorplasty Based on the Outcomes of a Case Series in Eight Patients.","authors":"Alexander A Gatskiy,&nbsp;Ihor B Tretyak,&nbsp;Jörg Bahm,&nbsp;Vitaliy I Tsymbaliuk,&nbsp;Yaroslav V Tsymbaliuk","doi":"10.1055/s-0043-1767672","DOIUrl":"10.1055/s-0043-1767672","url":null,"abstract":"<p><p><b>Background (rationale)</b>  Steindler flexorplasty (SF) is aimed at restoring independent elbow flexion in the late stages of dysfunction of the primary elbow flexors. Selection criteria for successful SF have been defined. <b>Objectives</b>  The purpose of this study was to redefine the inclusion criteria for successful SF based on functional outcomes. <b>Methods</b>  Eight patients received SF after an average of 50.8 months after injury or dysfunction. Three patients (37.5%) met all five Al-Qattan inclusion criteria (AQIC), and another five patients (62.5%) met four or less AQIC. Patients were followed up for at least 9 months, and the maximum range of active elbow flexion (REF) was measured. Functional results of SF were assessed using the Al-Qattan scale (in accordance with Al-Qattan's scale). <b>Results</b>  The mean maximum REF was 100 degrees (70 to 140 degrees). Five patients reached REF greater than 100 degrees. One patient had a poor outcome, two patients (25%) had a fair outcome, three patients (37.5%) had a good outcome, and two patients (25%) had an excellent outcome of SF on the Al-Qattan scale. The impact of each AQIC on functional outcome has been critically reviewed from a biomechanical point of view. <b>Conclusions</b>  The sufficient number of inclusion criteria required for successful SF can be reduced from five (according to AQIC) to two; Normal or near-normal function (M4 or greater on the MRC scale) of the muscles of the flexor-pronator mass should be considered an obligatory inclusion criterion, while primary wrist extensors may be considered an optional inclusion criterion.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"18 1","pages":"e32-e41"},"PeriodicalIF":0.7,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10567141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41202204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Surgical Treatment of Peripheral Neuromas of the Hand and Forearm.","authors":"Yousif Tarek El-Gammal,&nbsp;Laura Cardenas-Mateus,&nbsp;Tsu Min Tsai","doi":"10.1055/s-0043-1767673","DOIUrl":"https://doi.org/10.1055/s-0043-1767673","url":null,"abstract":"<p><p>The choice of a specific technique for surgical treatment of neuromas remains a problem. The purpose of this study is to determine the overall effectiveness of surgery as well as to find out whether certain surgical procedures are more effective than others. Twenty-nine patients operated between 1998 and 2018 and followed for at least 12 months were reviewed. Clinical assessment included the identification of a pre- and postoperative Tinel sign, pain visual analog score, two-point discrimination (2PD), and grip strength. Mechanisms of injury included clean lacerations (11), crush injuries (11), and other trauma or surgery (7). Mean time from presentation to surgery was 9 months. Seven surgical procedures involving excision in 10 patients and excision and nerve repair in 19 patients were performed. Pain score improved from an average of 7.1 ± 2.3 to 1.8 ± 1.7 with 27 patients (93%) reporting mild or no postoperative pain. Nine patients complained of residual scar hypersensitivity and six patients had residual positive Tinel. No patient required an additional surgical procedure. 2PD improved from an average of 9.6 ± 4.0 to 6.8 ± 1.0. The improvement of pain score and 2PD was statistically significant. Nerve repair resulted in marginally better outcomes, in terms of 2PD and grip strength recovery, than excision alone. The mechanism of injury, zone of involvement, time to intervention, or length of follow-up did not have an impact on the outcomes. Although patient numbers in this study are large in comparison to previous studies, larger patient numbers will allow for a multivariate analysis, which can be possible with a prospective multicenter trial.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"18 1","pages":"e6-e9"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9271281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes after Anterior Interosseous Nerve to Ulnar Motor Nerve Transfer.","authors":"Jeffrey N Gross,&nbsp;Steven E Dawson,&nbsp;Gerald J Wu,&nbsp;Scott Loewenstein,&nbsp;Gregory H Borschel,&nbsp;Joshua M Adkinson","doi":"10.1055/s-0042-1760097","DOIUrl":"https://doi.org/10.1055/s-0042-1760097","url":null,"abstract":"<p><p><b>Background</b>  Ulnar nerve lesions proximal to the elbow can result in loss of intrinsic muscle function of the hand. The anterior interosseous nerve (AIN) to deep motor branch of the ulnar nerve (DBUN) transfer has been demonstrated to provide intrinsic muscle reinnervation, thereby preventing clawing and improving pinch and grip strength. The purpose of this study was to evaluate the efficacy of the AIN to DBUN transfer in restoring intrinsic muscle function for patients with traumatic ulnar nerve lesions. <b>Methods</b>  We performed a prospective, multi-institutional study of outcomes following AIN to DBUN transfer for high ulnar nerve injuries. Twelve patients were identified, nine of which were enrolled in the study. The mean time from injury to surgery was 15 weeks. <b>Results</b>  At final follow-up (mean postoperative follow-up 18 months + 15.5), clawing was observed in all nine patients with metacarpophalangeal joint hyperextension of the ring finger averaging 8.9 degrees (+ 10.8) and small finger averaging 14.6 degrees (+ 12.5). Grip strength of the affected hand was 27% of the unaffected extremity. Pinch strength of the affected hand was 29% of the unaffected extremity. None of our patients experienced claw prevention after either end-to-end ( <i>n</i>  = 4) or end-to-side ( <i>n</i>  = 5) AIN to DBUN transfer. <b>Conclusion</b>  We conclude that, in traumatic high ulnar nerve injuries, the AIN to DBUN transfer does not provide adequate intrinsic muscle reinnervation to prevent clawing and normalize grip and pinch strength.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"18 1","pages":"e1-e5"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9833888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Preoperative Neuropraxia on Surgical Duration Following Pediatric Supracondylar Fracture of the Humerus: A Retrospective Cohort Study.","authors":"Yazeed Alayed,&nbsp;Bander S Alrashedan,&nbsp;Sultan K Almisfer,&nbsp;Ali M Aldossari","doi":"10.1055/s-0043-1771012","DOIUrl":"https://doi.org/10.1055/s-0043-1771012","url":null,"abstract":"<p><p><b>Background</b>  Supracondylar fractures of the humerus (SCFHs) are the most common type of elbow fracture in children. Because of the influence on functional outcome, neuropraxia is one of the most common concerns at presentation. The impact of preoperative neuropraxia on surgery duration is not extensively probed. The clinical implications of several other risk factors associated with preoperative neuropraxia at presentation may contribute to longer surgical duration of SCFH. <b>Hypothesis</b>  Preoperative neuropraxia is likely to increase surgery duration in patients who sustained SCFH. <b>Patients and Methods</b>  This is a retrospective cohort analysis. Sixty-six patients who sustained surgical pediatric supracondylar humerus fracture were included in the study. Baseline characteristics including age, gender, the type of fracture according to Gartland classification, mechanism of injury, patient weight, side of injury, and associated nerve injury were included in the study. Logistic regression analysis was performed using mean surgery duration as the main dependent variable and age, gender, fracture type according to the mechanism of injury, Gartland classification, injured arm, vascular status, time from presentation to surgery, weight, type of surgery, medial K-wire use, and afterhours surgery as the independent variables. A follow-up of 1 year was implemented. <b>Result</b>  The overall preoperative neuropraxia rate was 9.1%. The mean surgery duration was 57.6 ± 5.6 minutes. The mean duration of closed reduction and percutaneous pinning surgeries was 48.5 ± 5.3 minutes, whereas the mean duration of open reduction and internal fixation (ORIF) surgeries was 129.3 ± 15.1 minutes. Preoperative neuropraxia was associated with an overall increase in the surgery duration ( <i>p</i>  < 0.017). Bivariate binary regression analysis showed a significant correlation between the increase of surgery duration and flexion-type fracture (odds ratio = 11, <i>p</i>  < 0.038) as well as ORIF (odds ratio = 26.2, <i>p</i>  < 0.001). <b>Conclusion</b>  Preoperative neuropraxia and flexion-type fractures convey a potential longer surgical duration in pediatric supracondylar fracture. <b>Level of Evidence</b>  Prognostic III.</p>","PeriodicalId":15280,"journal":{"name":"Journal of Brachial Plexus and Peripheral Nerve Injury","volume":"18 1","pages":"e27-e31"},"PeriodicalIF":0.7,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9804927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}