Peripheral nerve repair throughout the body with processed nerve allografts: Results from a large multicenter study.

BACKGROUND: Peripheral nerve damage resulting in pain, loss of sensation, or motor function may necessitate a reconstruction with a bridging material. The RANGER® Registry was designed to evaluate outcomes following nerve repair with processed nerve allograft (Avance® Nerve Graft; Axogen; Alachua, FL). Here we report on the results from the largest peripheral nerve registry to-date. METHODS: This multicenter IRB-approved registry study collected data from patients repaired with processed nerve allograft (PNA). Sites followed their own standard of care for patient treatment and follow-up. Data were assessed for meaningful recovery, defined as ≥S3/M3 to remain consistent with previously published results, and comparisons were made to reference literature. RESULTS: The study included 385 subjects and 624 nerve repairs. Overall, 82% meaningful recovery (MR) was achieved across sensory, mixed, and motor nerve repairs up to gaps of 70 mm. No related adverse events were reported. There were no significant differences in MR across the nerve type, age, time-to-repair, and smoking status subgroups in the upper extremity (p > .05). Significant differences were noted by the mechanism of injury subgroups between complex injures (74%) as compared to lacerations (85%) or neuroma resections (94%) (p = .03) and by gap length between the <15 mm and 50-70 mm gap subgroups, 91 and 69% MR, respectively (p = .01). Results were comparable to historical literature for nerve autograft and exceed that of conduit. CONCLUSIONS: These findings provide clinical evidence to support the continued use of PNA up to 70 mm in sensory, mixed and motor nerve repair throughout the body and across a broad patient population.

Posttraumatic stress symptoms in children recovering from minor orthopaedic injury and treatment.

BACKGROUND: This study was designed to determine the prevalence of high levels of posttraumatic stress disorder (PTSD) symptoms among pediatric orthopaedic trauma patients recovering from injury and to see whether injury or demographic variables are associated with the presence of the symptoms. METHODS: Four hundred pediatric orthopaedic trauma patients completed the Child PTSD Symptom Scale questionnaire. Demographic and injury variables were tested to see if any were associated with the presence of high levels of posttraumatic stress symptoms. RESULTS: The average age of respondents was 11 years. The average time since injury was 36 days. The mean Injury Severity Score and summed Extremity Abbreviated Injury Score were 4 and 2, respectively. A total of 130 (33%) met criteria for high levels of PTSD symptoms. None of the variables tested were associated with high levels of PTSD symptoms, except one. Patients admitted to the hospital after injury were significantly more likely to develop high levels of PTSD symptoms. CONCLUSIONS: High levels of posttraumatic stress disorder symptoms are common in the recovery period after pediatric orthopaedic trauma, even among patients with relatively minor injury. Children admitted to the hospital after injury are at higher risk for such symptoms.