Introduction: Isolated musculocutaneous nerve injuries occur rarely due to their anatomical location. We present our patient with a musculocutaneous nerve injury in a motorcyclist. Case: The patient was initially treated for a motorcycle accident. Further examination of the patient revealed impaired elbow flexion and numbness of the lateral forearm. Electromyography confirmed impaired function of the musculocutaneous nerve. After 3 months, the patient‘s condition did not show any improvement, neither electromyography confirmed recovery of the nerve activity, so surgical treatment was planned. In the surgical revision, neuroma-in-continuity was discovered and resected. The resulting nerve defect was 6 cm long. We provided nerve grafting using sural nerve from the right lower limb. After surgery, the patient began physical therapy and electrical stimulation. Two years later, the patient reached complete recovery of muscle strength. Conclusion: Due to the lack of improvement after a 3-month period, we proceeded with a surgical revision, which demonstrated a complete lesion of the nerve that could not heal spontaneously. Therefore, we opted for the nerve graft method and the patient regained full function of elbow flexors.
- MeSH
- dopravní nehody MeSH
- dospělí MeSH
- lidé MeSH
- motocykly MeSH
- nervový přenos MeSH
- nervus musculocutaneus * chirurgie zranění MeSH
- nervus suralis transplantace MeSH
- poranění periferního nervu * chirurgie etiologie klasifikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Dual nerve transfer of the spinal accessory nerve to the suprascapular nerve (SAN-SSN) and the radial nerve to the axillary nerve is considered to be the most feasible method of restoration of shoulder abduction in brachial plexus injuries. Supraspinatus muscle plays an important role in the initiation of abduction and its functional restoration is crucial for shoulder movements. There are two possible approaches for the SAN-SSN transfer: the more conventional anterior approach and the posterior approach in the area of scapular spine, which allows more distal neurotization. Although the dual nerve transfer is a widely used method, it is unclear which approach for the SAN-SSN transfer results in better outcomes. We conducted a search of English literature from January 2001 to December 2021 using the PRISMA guidelines. Twelve studies with a total 142 patients met our inclusion criteria. Patients were divided into two groups depending on the approach used: Group A included patients who underwent the anterior approach, and Group B included patients who underwent the posterior approach. Abduction strength using the Medical Research Scale (MRC) and range of motion (ROM) were assessed. The average MRC grade was 3.57 ± 1.08 in Group A and 4.0 ± 0.65 (p = 0.65) in Group B. The average ROM was 114.6 ± 36.7 degrees in Group A and 103.4 ± 37.2 degrees in Group B (p = 0.247). In conclusion, we did not find statistically significant differences between SAN-SSN transfers performed from the anterior or posterior approach in patients undergoing dual neurotization technique for restoration of shoulder abduction.
- MeSH
- kognice MeSH
- lidé MeSH
- nervový transfer * MeSH
- nervus radialis MeSH
- rameno * chirurgie MeSH
- regenerace nervu MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- systematický přehled MeSH
INTRODUCTION: Radial nerve palsy after humeral shaft fractures is often associated with formation of a neuroma in continuity. The current standard of treatment is neuroma resection and nerve grafting with contentious results. Anterior transposition of the radial nerve may reduce the length of its path, allowing reconstruction by primary suture. The aim of this study was to determine the maximum length of radial nerve defect that can be treated by the anterior transposition to allow primary suture to be performed. METHODS: We use 10 arms from five fresh cadavers. The radial nerve was dissected in the lateral inter-muscular septum and along the anterior aspect of the forearm. The radial nerve was transected at the level of the spiral groove and both stumps were than transposed anterior to the medial inter-muscular septum. The length of tension-free overlap that could be achieved was measured. RESULTS: The average length of the overlap at zero degrees of elbow flexion was 10.00 ± 1.84 mm. Theoretically, this will allow a defect of 20 ± 3.69 mm SD to be treated by primary suture. CONCLUSION: Our results suggest that anterior transposition can be used for radial nerve defects up to 2 cm; however, dissection of both stumps proved to be challenging.
- MeSH
- kostní destičky MeSH
- lidé MeSH
- nervus radialis * chirurgie MeSH
- neurom * MeSH
- studie proveditelnosti MeSH
- sutura MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Introduction: It is often questioned whether to perform replantation or revision amputation for amputation injuries in elderly patients and smokers. According to the current indication criteria, neither old age nor smoking in the absence of other risk factors are considered to be risk factors for replantation failure. However, many microsurgeons still may make the decision not to perform digital replantation based solely on these factors. Material and methods: In order to evaluate the influence of both factors, we provided univariate and multivariate analyses of patients who underwent replantation at our centre during a 10-year period. We divided patients in two groups according to age (< and ≥ 60 years) and smoking status. Results: In the univariate analysis, there were no differences in immediate results between the two age groups. In the multivariate analysis, no statistical difference was found in neither long-term nor short-term results between the two age groups and between smokers and non-smokers. Conclusion: Smoking and age should not be considered the only risk factors when deciding whether to perform digital replantation.
OBJECTIVES: To investigate the anatomical feasibility of the infraspinatus branch of the suprascapular nerve (IB-SSN) reconstruction by lower subscapular nerve (LSN) transfer. METHODS: The morphological study was performed on 18 adult human cadavers. The length of the distal stump of the IB-SSN, the length of the LSN available for reconstruction and diameter of both stumps were measured. The feasibility study of the LSN to IB-SSN transfer was performed. RESULTS: The mean length of the IB-SSN to the end of its first branch was 40.9 mm (±4.6). Its mean diameter was 2.3 mm (±0.3). The mean length of the LSN stump, which was mobilized from its original course and transferred to reach the distal stump of the IB-SSN was 66.5 mm (±11.8). Its mean diameter was 2.1 mm (±0.3). The mean ratio between LSN and IB-SSN diameters was 0.9 (±0.1). The nerve transfer was feasible in 17 out of 18 cases (94.4%). CONCLUSION: This study demonstrates that direct LSN to IB-SSN transfer is anatomically feasible in most cases in the adult population. It may be used in cases of complex scapular fractures resulting in severe suprascapular nerve injury.
- MeSH
- dospělí MeSH
- lidé MeSH
- nervový transfer * metody MeSH
- plexus brachialis * chirurgie MeSH
- regenerace nervu fyziologie MeSH
- rotátorová manžeta MeSH
- studie proveditelnosti MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Restoring shoulder abduction is one of the main priorities in the surgical treatment of brachial plexus injuries. Double nerve transfer to the axillary nerve and suprascapular nerve is widely used and considered the best option. The most common donor nerve for the suprascapular nerve is the spinal accessory nerve. However, donor nerves for axillary nerve reconstructions vary and it is still unclear which donor nerve has the best outcome. The aim of this study was to perform a systematic review on reconstructions of suprascapular and axillary nerves and to perform a meta-analysis investigating the outcomes of different donor nerves on axillary nerve reconstructions. We conducted a systematic search of English literature from March 2001 to December 2020 following PRISMA guidelines. Two outcomes were assessed, abduction strength using the Medical Research Council (MRC) scale and range of motion (ROM). Twenty-two studies describing the use of donor nerves met the inclusion criteria for the systematic review. Donor nerves investigated included the radial nerve, intercostal nerves, medial pectoral nerve, ulnar nerve fascicle, median nerve fascicle and the lower subscapular nerve. Fifteen studies that investigated the radial and intercostal nerves met the inclusion criteria for a meta-analysis. We found no statistically significant difference between either of these nerves in the abduction strength according to MRC score (radial nerve 3.66 ± 1.02 vs intercostal nerves 3.48 ± 0.64, p = 0.086). However, the difference in ROM was statistically significant (radial nerve 106.33 ± 39.01 vs. intercostal nerve 80.42 ± 24.9, p < 0.001). Our findings support using a branch of the radial nerve for the triceps muscle as a donor for axillary nerve reconstruction when possible. Intercostal nerves can be used in cases of total brachial plexus injury or involvement of the C7 root or posterior fascicle. Other promising methods need to be studied more thoroughly in order to validate and compare their results with the more commonly used methods.
- MeSH
- lidé MeSH
- nervový transfer * metody MeSH
- nervus accessorius chirurgie MeSH
- neuropatie brachiálního plexu * chirurgie MeSH
- plexus brachialis * zranění chirurgie MeSH
- rameno inervace chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- systematický přehled MeSH
The suprascapular nerve (SSN) is commonly reconstructed by spinal accessory nerve (SAN) transfer. However, reinnervation of its branch to the infraspinatus muscle (IB-SSN) is poor. Reconstruction of the SSN in cases of scapular fractures is frequently neglected in clinical practice. The morphological study was performed on 25 adult human cadavers. The course and the length of SSN of minimal diameter of 2 mm within the trapezius muscle, the length of the distal stump of IB-SSN to its branching point and the length of the SSN available for reconstructive procedure were measured. The feasibility study of the SAN - IB-SSN neurotization performed by using a bony canal under the spine of scapula was performed. The mean distance of the SAN from the spine was 8.5 cm (±0.88) at the point where it perforates the trapezius muscle and 4.49 cm (±0.72) at the most distal part of the nerve. The mean length of the intramuscular portion of the nerve was 14.74 cm (±1.99). It ran under a mean latero-medial angle of 15.54° (±2.51). The mean distance between the medial end of the scapular spine and the SAN was 2.44 cm (± 0.64). The mean length of the IB-SSN was 3.6 cm (± 0.67). The mean length of the SAN stump which was mobilized from its original course and transferred to the infraspinous fossa to reach distal stump of the IB-SSN was 8.09 cm (±1.6). Direct SAN to IB-SSN transfer is anatomically feasible in the adult population.
- MeSH
- dospělí MeSH
- lidé MeSH
- nervový transfer * MeSH
- nervus accessorius chirurgie MeSH
- povrchové zádové svaly * chirurgie MeSH
- regenerace nervu MeSH
- rotátorová manžeta MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Léze n. radialis doprovází až 20 % zlomenin diafýzy pažní kosti. Dvě třetiny nálezů vznikají v souvislosti s úrazovým mechanizmem (primární) a jedna třetina během konzervativní nebo operační léčby (sekundární, tj. iatrogenní léze). I když má většina těchto postižení dobrou prognózu a lze očekávat spontánní návrat funkce, existují situace, kdy nelze bez operační revize reinervace dosáhnout. Jedná se o lacerace či inkarcerace nervu mezi kostní úlomky či těžká trakční postižení se vznikem jizevnatého neuromu v kontinuitě. Takto závažná postižení se vyskytují u necelé poloviny revidovaných případů. Časná intervence má lepší prognózu než konzervativní léčba s eventuální pozdní revizí při trvání denervačního syndromu. Proto je dle současných literárních dat u většiny případů poranění radiálního nervu v souvislosti se zlomeninou pažní kosti doporučena brzká revize do 3 týdnů s ohledem na celkový stav pacienta, postižené končetiny, mechanizmus úrazu a výsledky pomocných vyšetření.
Radial nerve palsy accompanies up to 20% of humeral shaft fractures. Two thirds of the findings occur in connection with the injury mechanism (primary palsy) and one third during conservative or surgical treatment (secondary, i.e., iatrogenic palsy). Although most of these injuries have a good prognosis and spontaneous return of function can be expected, there are situations where reinnervation cannot be achieved without surgical revision. These are lacerations or incarcerations of the nerve between bone fragments or severe traction lesions causing scarring and neuroma-in-continuity formation. Such serious findings are present in less than one half of the cases requiring surgical intervention. Early intervention has a higher success rate than conservative treatment (with possible late revision in case of persistence of denervation). Therefore, according to current literature data, early revision within 3 weeks is recommended in most cases of radial nerve palsy associated with humeral fracture with respect to the general condition of the patient, affected limb, mechanism of injury, and the results of complementary examinations.
- Klíčová slova
- traumatický neurom,
- MeSH
- fraktury humeru chirurgie diagnóza MeSH
- lidé MeSH
- nervus radialis * zranění MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
- Klíčová slova
- ranivá balistika, ranivý potenciál, fragmentace střely,
- MeSH
- poranění ruky MeSH
- první pomoc MeSH
- střelné rány terapie MeSH
