Asociated injuries of the peripheral nerves of the foreartm and management of surgical treatment

Abstract

Introduction. Repair of a peripheral nerve has considerable functional consequences for the individual, due to sensory and motor loss, as well as the pain and discomfort from cold intolerance. Material and methods Our experience refere to the period 1998-2016 years based on the treatment of 104 patients with associated nerve injuries. Patients were aged between 16 and 65 year, 83 were male and 21 female; in 87 cases the nerve lesions were associated with flexor tendons injuries and in 42 cases with a variety of fractures. Nerve injuries consisted in multiple lesions of the proper digital nerves - 16 cases, lesions of the common digital nerves at palm level - 19 cases, lesions of the median or ulnar nerves in the forearm - 50 cases, combined injuries of median and ulnar nerves were found in 19 cases. Primary surgical approach included anatomical restoration of skeletal and tendinous elements. In 54 the nerve reconstruction was also performed, utilizing epyperineurorraphy in 61 cases and the epyneurorraphy in 7 cases, neurolizis in 29 cases. In 7 cases with irreparable radial nerve palsy we used with successful transfers of muscle tendon. Results and discussion There still are discussions about the optimal posttraumatic delay for nerve reconstruction, but one condition must be clear: injuries of the nerves in the harul require - especially if the motor component is involved - an as early as possible surgical approach. As above mentioned, we performed primary neurorraphy in 54 cases. Results were considered good in 18 cases, satisfactory in 31 and poor in 5 cases. Microscopic techniques utilizing atraumatic materials combined with an active postoperative recuperatory management allowed us to obtain favorable results in associated injuries of the hand. In 24 cases the lesions were associated with fractures of the humerus bone, in 4 cases - with fractures of the radial bone. The open lesion of the nerve was present în 6 cases, in 2 of which was lesioned the median nerve, in 1 – was lesioned the median, ulnar and radial nerves. In 7 cases with irreparable radial nerve palsy we used with successful transfers of muscle tendon. The long term results were followed for 7 pacients. Good results were registered in 4 cases, satisfactory 3 cases.