Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 6/2022

05-05-2022 | Original Article

Treatment of upper extremity nerve defects by direct suturing in high elbow or wrist flexion

Authors: Laurent Mathieu, Constance Diner, Anaïs Chataigneau, Georges Pfister, Christophe Oberlin, Zoubir Belkheyar

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2022

Login to get access

Abstract

Purpose

To evaluate functional outcomes after direct suturing of upper extremity nerve defects in high elbow or wrist flexion.

Methods

A retrospective review was conducted in patients treated for median, ulnar, or radial nerve defects between 2011 and 2019. Inclusion criteria were a defect > 1 cm and a minimal follow-up period of 1 year. Nerve defects were bridged by an end-to-end suture in 90° elbow flexion or 70° wrist flexion for 6 weeks.

Results

Nine patients with a mean age of 30.2 years were included. The patients presented with two ulnar nerve defects, four median nerve defects, and three radial nerve defects at various levels. The mean time to surgery was 13.5 weeks for recent injuries. The mean defect length was 2.9 cm, and the mean follow-up time was 22.4 months. Two patients had joint stiffness that was more likely related to the associated injuries than the 6-week immobilization. Successful outcomes were achieved in eight of the nine patients. Meaningful motor recovery was observed in seven patients, and all recovered meaningful sensation. Excellent nerve recovery was noted in pediatric patients and in those with distal nerve defects.

Conclusion

Temporary high joint flexion allows for direct coaptation of upper extremity nerve defects up to 4 cm located near the elbow or wrist. In this small and heterogenous cohort, functional outcomes seemed to be comparable to those obtained with short autografting.
Literature
1.
Griffin JW, Hogan MV, Chhabra AB, Deal DN. Peripheral nerve repair and reconstruction. J Bone Joint Surg Am. 2013;95:2144–55.CrossRefPubMed
2.
Boyd KU, Fox IK. Nerve repair and grafting. In: Mackinnon SE, editor. Nerve surgery. New York: Thieme Medical Publishers; 2015. p. 75–100.
3.
Millesi H. The interfascicular nerve grafting of the median and the ulnar nerves. J Bone Joint Surg Am. 1972;54:727–50.CrossRefPubMed
4.
Driscoll PJ, Glasby MA, Lawson GM. An in vivo study of peripheral nerves in continuity: biomechanical and physiological responses to elongation. J Orthop Res. 2002;20:370–5.CrossRefPubMed
5.
Mathieu L, Pfister G, Murison JC, Oberlin C, Belkheyar Z. Missile injury of the sciatic nerve: observational study supporting early exploration and direct suture with flexed knee. Mil Med. 2019;184:e937–44.CrossRefPubMed
6.
Mathieu L, Addas BMJ, Irimura SC, Oberlin C, Belkheyar Z. Management of sciatic nerve defects: lessons learned and proposal for a new strategy. Ann Plast Surg. 2020;84:559–64.CrossRefPubMed
7.
Bourrel P. Favorable results of sciatic nerve suturing performed 15 months after sectioning. Value of repeated exploratory surgery 2 months after the suturing. Mars Chir. 1965;175:203–8.
8.
Bourrel P, De Bisschop G. Suture of the sciatic nerve performed 15 months after its section. Result 2 years later. Value of repeated exploration. Ann Chir. 1966;20:1145–9.PubMed
9.
10.
Pfister G, Ghabi A, de Carbonnières A, Oberlin C, Belkheyar Z, Mathieu L. Direct suturing of sciatic nerve defects in high-degree knee flexion: an experimental study. World Neurosurg. 2020;133:e288–92.CrossRefPubMed
11.
12.
Roganovic Z. Missile-caused ulnar nerve injuries: outcomes of 128 repairs. Neurosurgery. 2004;55:1120–9.CrossRefPubMed
13.
Roganovic Z. Missile-caused median nerve injuries: results of 81 repairs. Surg Neurol. 2005;63:410–8.CrossRefPubMed
14.
Trumble TE. Overcoming defects in peripheral nerves. In: Gelberman RH, editor. Operative nerve repair and reconstruction. 1st ed. Philadelphia: JB Lippincott; 1991. p. 507–23.
15.
Abrams RA, Fenichel AS, Callahan JJ, Brown RA, Botte MJ, Lieber RL. The role of ulnar nerve transposition in ulnar nerve repair: a cadaver study. J Hand Surg. 1998;23A:244–9.CrossRef
16.
Choudhry IK, Bracey DN, Hutchinson ID, Li Z. Comparison of transposition techniques to reduce gap associated with high ulnar nerve lesions. J Hand Surg Am. 2014;39:2460–3.CrossRefPubMed
17.
Smetana BS, Jernigan EW, Rummings WA Jr, Weinhold PS, Draeger RW, Patterson MM. Submuscular versus subcutaneous ulnar nerve transposition: a cadaveric model evaluating their role in primary ulnar nerve repair at the elbow. J Hand Surg Am. 2017;42(571):e1-7.
18.
19.
Medical research council of the United Kingdom. Aids to the examination of peripheral nervous system. Memorandum No. 45, London, Her Majesty’s Stationery Office, 1976.
20.
Kim DH, Kam AC, Chandika P. Surgical management and outcomes in patients with median nerve lesions. J Neurosurg. 2001;95:584–94.CrossRefPubMed
21.
Kim DH, Kam AC, Chandika P, Tiel RL, Kline DG. Surgical management and outcome in patients with radial nerve lesions. J Neurosurg. 2001;95:573–83.CrossRefPubMed
22.
Kim DH, Han K, Tiel RL, Murovic JA, Kline DG. Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg. 2003;98:993–1004.CrossRefPubMed
23.
24.
Murovic JA. Upper-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 1837 Louisiana State University Health Sciences Center median, radial, and ulnar nerve lesions. Neurosurgery. 2009;65:A11–7.CrossRefPubMed
25.
Ruijs AC, Jaquet JB, Kalmijn S, Giele H, Hovius SER. Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg. 2005;116:495–6.CrossRef
26.
Pan CH, Chuang DCC, Rodríguez-Lorenzo A. Outcomes of nerve reconstruction for radial nerve injuries based on the level of injury in 244 operative cases. J Hand Surg Eur. 2010;35:385–91.CrossRef
27.
Ramachandran M, Birch R, Eastwood DM. Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children. The experience of a specialist referral centre. J Bone Joint Surg [Br]. 2006;88B:90–4.CrossRef
28.
Kwok IHY, Silk ZM, Quick TJ, Sinisi M, MacQuillan A, Fox M. Nerve injuries associated with supracondylar fractures of the humerus in children. Our experience in a specialist peripheral nerve injury unit. Bone Joint J. 2016;98-B:851–6.CrossRefPubMed
29.
Hagemann C, Harhaus L. Combined distal nerve and tendon transfer in drop wrist for treatment of high injuries of the radial nerve. Oper Orthop Traumatol. 2021;33:399–404.CrossRefPubMed
30.
Acciari N, Davalli C, Poppi M, Scoto S, Staffa G. Interruption of the radial nerve at proximal level: reconstruction following anterior transposition. Chir Organi Mov. 1998;83:435–40.
Metadata
Title
Treatment of upper extremity nerve defects by direct suturing in high elbow or wrist flexion
Authors
Laurent Mathieu
Constance Diner
Anaïs Chataigneau
Georges Pfister
Christophe Oberlin
Zoubir Belkheyar
Publication date
05-05-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 6/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-022-01986-z

Other articles of this Issue 6/2022

European Journal of Trauma and Emergency Surgery 6/2022 Go to the issue

Original Article

Comparison of fluoroscopy and fluoroscopy-based 2D computer navigation for iliosacral screw placement: a retrospective study

Original Article

Advanced CT visualization improves the accuracy of orthopaedic trauma surgeons and residents in classifying proximal humeral fractures: a feasibility study

Original Article

Does the magnitude of injuries affect the outcome of proximal humerus fractures treated by locked plating (PHILOS)?

Original Article

Epidemiology of clavicle shaft fractures in a public hospital in South Africa: differences between developing and developed countries

Original Article

The influence of preoperative CT imaging on surgical delay in patients with acutely symptomatic abdominal wall hernias

Original Article

The conundrum of the definition of haemorrhagic shock: a pragmatic exploration based on a scoping review, experts’ survey and a cohort analysis