Mechanisms, interventions at risk and clinical presentation of iatrogenic nerve lesions in trauma patients.

Autor: Aman M; Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Plastic and Reconstructive Surgery, Burn Center, Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany. martin.aman@bgu-ludwigshafen.de., Zimmermann KS; Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Plastic and Reconstructive Surgery, Burn Center, Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany., Pennekamp A; Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Plastic and Reconstructive Surgery, Burn Center, Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany., Thielen M; Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Plastic and Reconstructive Surgery, Burn Center, Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany., Falkner F; Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Plastic and Reconstructive Surgery, Burn Center, Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany., Eisa A; Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Plastic and Reconstructive Surgery, Burn Center, Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany., Boecker AH; Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Plastic and Reconstructive Surgery, Burn Center, Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany., Harhaus L; Department of Handsurgery, Peripheral Nerve Surgery and Rehabilitation, Clinic of Plastic and Reconstructive Surgery, Burn Center, Department of Hand- and Plastic Surgery, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany.
Jazyk: angličtina
Zdroj: Archives of orthopaedic and trauma surgery [Arch Orthop Trauma Surg] 2023 Dec; Vol. 143 (12), pp. 7245-7253. Date of Electronic Publication: 2023 Aug 18.
DOI: 10.1007/s00402-023-05009-3
Abstrakt: Background: Iatrogenic nerve lesions during surgical interventions are avoidable complications that may cause severe functional impairment. Hereby, awareness of physicians and knowledge of structures and interventions at risk is of utmost importance for prevention. As current literature is scarce, we evaluated all patients treated surgically due to peripheral nerve injuries in our specialized nerve center for the presence of iatrogenic nerve lesions.
Methods: We evaluated a total of 5026 patients with peripheral nerve injuries treated over a time period of 8 years in our facility for the prevalence of iatrogenic nerve injuries, their clinical presentations, time to treatment, mechanisms and intraoperative findings on nerve continuity.
Results: A total of 360 (6.1%) patients had an iatrogenic cause resulting in 380 injured nerves. 76.6% of these lesions affected the main branch of the injured nerve, which were mainly the radial (30.5%), peroneal (13.7%) and median nerve (10.3%). After a mean delay of 237 ± 344 days, patients presented 23.2% with a motor and 27.9% with a mixed sensory and motor deficit. 72.6% of lesions were in-continuity lesions. Main interventions at risk are displayed for every nerve, frequently concerning osteosyntheses but also patient positioning and anesthesiologic interventions.
Discussion: Awareness of major surgical complications such as iatrogenic nerve injuries is important for surgeons. An often-seen trivialization or "watch and wait" strategy results in a huge delay for starting an adequate therapy. The high number of in-continuity lesions mainly in close proximity to osteosyntheses makes diagnosis and treatment planning a delicate challenge, especially due to the varying clinical presentations we found. Diagnostics and therapy should therefore be performed as early as possible in specialized centers capable of performing nerve repair as well as salvage therapies.
(© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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