Results of treatment for the posttraumatic neuropathies of peripheral nerves of the upper limb in children

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Abstract

BACKGROUND: Peripheral nerve injuries are severe types of injury with potential life-long impairment, which is crucial in the pediatric population. Considering the lack of literature on pediatric nerve lesions, we analyzed the results of treatment for children with injuries of the peripheral nerves of the upper extremities in the Department of Microsurgery of the N.F. Filatov Children's City Clinical Hospital.

AIM: This study aimed to evaluate the results of treatment for children with injuries of the peripheral nerves of the upper limb and to establish the relationship between the recovery of the function of the upper limb and the time elapsed from the moment of injury to surgery.

MATERIALS AND METHODS: From 2017 to 2021, 114 patients with injuries of the peripheral nerves of the upper limb were treated in the Department of Microsurgery. The following data were extracted from the case histories and at the follow-up appointment: age, gender, level of damage, type of surgical intervention, period from the moment of injury to surgical intervention, and postoperative recovery of peripheral nerve functions. For the assessment of the sensory function of the nerves, a discriminatory two-point sensitivity test (Weber Test) and the Grigorovich scale were used. Electromyographic and ultrasound studies were also performed. Subjective feelings were assessed using the QuickDash questionnaire. The digital data were subjected to statistical processing.

RESULTS: Analysis of the results of treatment for children with different periods from the moment of injury to surgery found no differences among the groups up to 14 days and more than 14 days (p > 0.05). For further data analysis, the patients were divided into four groups depending on the period from the moment of injury to surgery: 1) up to 3 months, 2) from 3 to 6 months, 3) from 6 to 12 months, and 4) more than 12 months. No differences were found in the results (p > 0.05). According to the evaluation of the effect of age on the recovery of peripheral nerve function, better recovery of sensitivity was observed at the age of up to 11 years compared with at the age of more than 11 years (p < 0.05).

CONCLUSIONS: Considering the lack of statistically significant differences in the results of treatment for children at various times from the moment of injury to surgery, we can conclude that a period of more than 12 months from the moment of injury to surgery does not influence the achievement of satisfactory results of reconstructive surgical interventions for peripheral nerves in children.

About the authors

Alexander A. Smirnov

Pirogov Russian National Research Medical University; Filatov Children’s City Clinical Hospital

Email: smirnov_aan@bk.ru
ORCID iD: 0000-0002-7274-8291
SPIN-code: 4994-9364

postgraduate student; surgeon

Russian Federation, Moscow; Moscow

Vsevolod V. Rybchenok

Filatov Children’s City Clinical Hospital; Research Institute of Clinical Surgery, Pirogov Russian National Research Medical University

Email: sevasurgeon@gmail.com
ORCID iD: 0000-0001-9635-891X
SPIN-code: 2545-8675

Dr. Sci. (Med.), chief research associate of Research Institute of clinical surgery; surgeon of the Department of reconstructive microsurgery

Russian Federation, Moscow; Moscow

Alexander V. Alexandrov

Filatov Children’s City Clinical Hospital

Email: alexmicrosurg@mail.ru
ORCID iD: 0000-0002-6110-2380
SPIN-code: 5229-0038

head of the Department of reconstructive microsurgery

Russian Federation, Moscow

Pavel V. Goncharuk

Filatov Children’s City Clinical Hospital

Email: gonelpav@rambler.ru
ORCID iD: 0000-0002-9560-037X
SPIN-code: 6801-9875

surgeon of the Department of reconstructive microsurgery

Russian Federation, Moscow

Lamiya Ya. Idris

Pirogov Russian National Research Medical University

Email: idrislamiya@mail.ru
ORCID iD: 0000-0002-4902-7939
SPIN-code: 1193-7787

postgraduate student of the Department of pediatric surgery

Russian Federation, Moscow

Ruslan A. Khagurov

Filatov Children’s City Clinical Hospital

Email: dr.khagurov@gmail.com
ORCID iD: 0000-0001-7944-8438

surgeon of the Department of reconstructive microsurgery

Russian Federation, Moscow

Alexander N. Evdokimov

Filatov Children’s City Clinical Hospital

Email: pediatrix@yandex.ru
ORCID iD: 0000-0002-9113-3612
SPIN-code: 9432-3519

surgeon of the Department of reconstructive microsurgery

Russian Federation, Moscow

Nataliya A. Knyazeva

Pirogov Russian National Research Medical University

Author for correspondence.
Email: nata-knya@yandex.ru
ORCID iD: 0009-0004-0771-6922

student

Russian Federation, Moscow

References

  1. Huckhagel T, Nüchtern J, Regelsberger J, Lefering R. Nerve injury in severe trauma with upper extremity involvement: evaluation of 49,382 patients from the TraumaRegister DGU® between 2002 and 2015. Scand J Trauma Resusc Emerg Med. 2018;26(1):76. doi: 10.1186/s13049-018-0546-6
  2. Tapp M, Wenzinger E, Tarabishy S, et al. The Epidemiology of upper extremity nerve injuries and associated cost in the US Emergency Departments. Ann Plast Surg. 2019;83(6):676–680. doi: 10.1097/SAP.0000000000002083
  3. Asplund M, Nilsson M, Jacobsson A, von Holst H. Incidence of traumatic peripheral nerve injuries and amputations in Sweden between 1998 and 2006. Neuroepidemiology. 2009;32(3):217–228. doi: 10.1159/000197900
  4. Kim SJ, Kwon YM, Ahn SM, et al. Epidemiology of upper extremity peripheral nerve injury in South Korea, 2008 to 2018. Medicine (Baltimore). 2022;101(48):e31655. doi: 10.1097/MD.0000000000031655
  5. Aman M, Zimmermann KS, Boecker AH, et al. Peripheral nerve injuries in children-prevalence, mechanisms and concomitant injuries: a major trauma center’s experience. Eur J Med Res. 2023;28(1):116. doi: 10.1186/s40001-023-01082-x
  6. Eser F, Aktekin LA, Bodur H, Atan C. Etiological factors of traumatic peripheral nerve injuries. Neurol India. 2009;57(4):434–437. doi: 10.4103/0028-3886.55614
  7. Valencia J, Leyva F, Gomez-Bajo GJ. Pediatric hand trauma. Clin Orthop Relat Res. 2005;432:77–86. doi: 10.1097/01.blo.0000155376.88317.b7
  8. Kouyoumdjian JA, Graça CR, Ferreira VFM. Peripheral nerve injuries: A retrospective survey of 1124 cases. Neurol India. 2017;65(3):551–555. doi: 10.4103/neuroindia.NI_987_16
  9. Missios S, Bekelis K, Spinner RJ. Traumatic peripheral nerve injuries in children: epidemiology and socioeconomics. J Neurosurg Pediatr. 2014;14(6):688–694. doi: 10.3171/2014.8.PEDS14112
  10. Nofsinger CC, Wolfe SW. Common pediatric hand fractures. Curr Opin Pediatr. 2002;14(1):42–45. doi: 10.1097/00008480-200202000-00007
  11. Hosalkar HS, Matzon JL, Chang B. Nerve palsies related to pediatric upper extremity fractures. Hand Clin. 2006;22(1):87–98. doi: 10.1016/j.hcl.2005.12.004
  12. Khan MA, Vakhova EL, Aleksandrov AV, et al. Modern technologies of medical rehabilitation of children with post-traumatic neuropathies of the upper extremities. Bulletin of Rehabilitation Medicine. 2021;20(4):72–81. (In Russ.) doi: 10.38025/2078-1962-2021-20-4-72-81
  13. Bogolyubsky YA, Fayn AM, Sachkov AV, et al. Iatrogenic damage to the radial nerve during osteosynthesis of the humerus. Prevention, diagnosis and treatment. Russian Sklifosovsky Journal “Emergency Medical Care”. 2020;9(1):51–60. (In Russ.) doi: 10.23934/2223-9022-2020-9-1-51-60
  14. Barrios C, Amillo S, de Pablos J, Cañadell J. Secondary repair of ulnar nerve injury. 44 cases followed for 2 years. Acta Orthop Scand. 1990;61(1):46–49. doi: 10.3109/17453679008993065
  15. Carlsen BT, Bishop AT, Shin AY. Late reconstruction for brachial plexus injury. Neurosurg Clin N Am. 2009;20(1):51–64. doi: 10.1016/j.nec.2008.07.021
  16. Patterson JMM, Russo SA, El-Haj M, et al. Radial nerve palsy: nerve transfer versus tendon transfer to restore function. HAND. 2022;17(6):1082–1089. doi: 10.1177/1558944720988126
  17. Langridge B, Griffin MF, Akhavani MA, Butler PE. Long-term outcomes following pediatric peripheral nerve injury repair. J Hand Microsurg. 2020;12(1):27–31. doi: 10.1055/s-0039-1692928
  18. Grigorovich KA. Khirurgicheskoe lechenie povrezhdenii nervov. Moscow: Meditsina, 1981. 304 p. (In Russ.)
  19. Trescot AM, editor. Peripheral nerve entrapments: Clinical diagnosis and management. Springer International Publishing, 2016. 887 p.
  20. Domkundwar S, Autkar G, Khadilkar SV, Virarkar M. Ultrasound and EMG-NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies. J Ultrasound. 2017;20(2):111–122. doi: 10.1007/s40477-016-0232-3
  21. Liu F, Zhu J, Wei M, et al. Preliminary evaluation of the sural nerve using 22-MHz ultrasound: a new approach for evaluation of diabetic cutaneous neuropathy. PLoS One. 2012;7(4):e32730. doi: 10.1371/journal.pone.0032730
  22. Mota SJ, Silva FP, Gil-Pereira M, et al. Peripheral nerve ultrasound — anatomy and technique for diagnosis and procedures. 2014. 48 p.
  23. Ray WZ, Mahan MA, Guo D, et al. Erratum to: an update on addressing important peripheral nerve problems: challenges and potential solutions. Acta Neurochir (Wien). 2017;159(9):1775. doi: 10.1007/s00701-017-3232-y
  24. Berde CB, Strichartz GR. Local anesthetics. In: Miller R., Eriksson L., Fleisher L., et al. Miller’s anesthesia. 7th edition. Elsevier, 2009. doi: 10.1016/B978-0-443-06959-8.00030-3
  25. Miner JR, Paris PM, Yealy DM. Pain management. Marx J, Hockberger R, editors. Mark Rosen’s emergency medicine. 7th edition. Mosby, 2010. doi: 10.1016/B978-0-323-05472-0.00186-9
  26. Ludwin SK, Maitland M. Long-term remyelination fails to reconstitute normal thickness of central myelin sheaths. J Neurol Sci. 1984;64(2):193–198. doi: 10.1016/0022-510x(84)90037-6
  27. Udina E, Ceballos D, Gold BG, Navarro X. FK506 enhances reinnervation by regeneration and by collateral sprouting of peripheral nerve fibers. Exp Neurol. 2003;183(1):220–231. doi: 10.1016/s0014-4886(03)00173-0
  28. Menorca RM, Fussell TS, Elfar JC. Nerve physiology: mechanisms of injury and recovery. Hand Clin. 2013;29(3):317–330. doi: 10.1016/j.hcl.2013.04.002
  29. Dahlin LB. Chapter 1: Nerve injury and repair: from molecule to man. Peripheral nerve surgery — practical applications in the upper extremity. In: Slutsky DJ, Hentz VR, editors. Peripheral Nerve Surgery. Churchill Livingstone, 2006. P. 1–22. doi: 10.1016/B978-0-443-06667-2.50006-X
  30. Johnson EO, Soucacos PN. Nerve repair: experimental and clinical evaluation of biodegradable artificial nerve guides. Injury. 2008;39(3):S30–S36. doi: 10.1016/j.injury.2008.05.018
  31. Li R, Liu Z, Pan Y, et al. Peripheral nerve injuries treatment: a systematic review. Cell Biochem Biophys. 2014;68(3):449–454. doi: 10.1007/s12013-013-9742-1
  32. Sameem M, Wood TJ, Bain JR. A systematic review on the use of fibrin glue for peripheral nerve repair. Plast Reconstr Surg. 2011;127(6):2381–2390. doi: 10.1097/PRS.0b013e3182131cf5
  33. Jiang X, Lim SH, Mao H-Q, Chew SY. Current applications and future perspectives of artificial nerve conduits. Exp Neurol. 2010;223(1):86–101. doi: 10.1016/j.expneurol.2009.09.009
  34. Gu X, Ding F, Yang Y, Liu J. Construction of tissue engineered nerve grafts and their application in peripheral nerve regeneration. Prog Neurobiol. 2011;93(2):204–230. doi: 10.1016/j.pneurobio.2010.11.002
  35. Nichols CM, Brenner MJ, Fox IK, et al. Effects of motor versus sensory nerve grafts on peripheral nerve regeneration. Exp Neurol. 2004;190(2):347–355. doi: 10.1016/j.expneurol.2004.08.003
  36. Panseri S, Cunha C, Lowery J, et al. Electrospun micro- and nanofiber tubes for functional nervous regeneration in sciatic nerve transections. BMC Biotechnol. 2008;8:39. doi: 10.1186/1472-6750-8-39
  37. Muir D. The potentiation of peripheral nerve sheaths in regeneration and repair. Exp Neurol. 2010;223(1):102–111. doi: 10.1016/j.expneurol.2009.05.038
  38. Mackinnon SE, Doolabh VB, Novak CB, Trulock EP. Clinical outcome following nerve allograft transplantation. Plast Reconstr Surg. 2001;107(6):1419–1429. doi: 10.1097/00006534-200105000-00016
  39. Zhang Y, Luo H, Zhang Z, et al. A nerve graft constructed with xenogeneic acellular nerve matrix and autologous adipose-derived mesenchymal stem cells. Biomaterials. 2010;31(20):5312–5324. doi: 10.1016/j.biomaterials.2010.03.029
  40. Pierucci A, de Duek EA, de Oliveira AL. Peripheral nerve regeneration through biodegradable conduits prepared using solvent evaporation. Tissue Eng Part A. 2008;14(5):595–606. doi: 10.1089/tea.2007.0271

Supplementary files

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2. Fig. 1. Scheme of sensitive innervation of the hand: U — ulnar nerve; M — median nerve; R — radial nerve

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3. Fig. 2. Definition of a discriminatory two-point test (Weber test)

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4. Fig. 3. Gender and age ratio of groups 1 and 2

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5. Fig. 4. Comparison of the results of treatment for children at different times from the moment of injury to surgical treatment

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6. Fig. 5. Comparison of the results of treatment for children with different levels of trauma

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7. Fig. 6. Comparison of the results of treatment for children depending on age

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