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1.
Unfallchirurg ; 123(3): 225-237, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32077972

RESUMO

Lesions of peripheral nerves substantially influence the long-term prognosis and functional outcome. Approximately 70% of peripheral nerval lesions are associated with vascular injuries and occur more frequently with certain fractures and osteosynthesis types. The prognosis and treatment depend on the severity of the injury and the presence of axonal lesions, in particular, determines the further procedure. Treatment as early as possible is associated with a clear improvement in the prognosis. Defects longer than 8 mm in size necessitate a nerve transplantation. Iatrogenic vascular lesions occur particularly in percutaneous interventions and are reported in up to 8% of cases after operations involving the musculoskeletal system. Iatrogenic nerve lesions are almost exclusively the result of surgical procedures and represent up to 17.5% of traumatic nerve injuries. For all lesions the general principles of surgical treatment are valid and the rapid involvement of professional expertise is decisive.


Assuntos
Fraturas Ósseas , Doenças Neuromusculares , Traumatismos dos Nervos Periféricos , Extremidades , Fraturas Ósseas/complicações , Humanos , Doença Iatrogênica , Doenças Neuromusculares/etiologia , Traumatismos dos Nervos Periféricos/etiologia , Resultado do Tratamento
2.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 92-95, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958939

RESUMO

Extralevator abdominoperineal excision (ELAPE) has been suggested to potentially improve oncological outcomes in advanced low rectal cancer patients. However, the urogenital function impairment as one of the main complications deteriorates the quality of life in these patients. The key point to prevent urogenital function impairment is to avoid autonomic nerve injury, including the superior and inferior hypogastric nerve plexus and neurovascular bundle. Three areas should be especially focused during surgery, including the posterolateral aspect of the prostate during the separation of the rectum from prostate, the lateral wall of ischioanal fossa and the area in front of anal canal. Previous presumption supposed that extended resection, though promoting oncologic outcomes, might lead to enlarged injury to surrounding vessels and nerves that deteriorated patients' urogenital function. But recent studies show that postoperative urogenital function outcomes of rectal cancer patients who underwent ELAPE are not inferior to conventional APE after the induction of minimal invasive approaches including laparoscopic and robotic surgery. Their quality of life can be comparable with patients who underwent conventional APE, and are even better in some particular area. Moreover, as further improvement of ELAPE procedure has been made, the concept of individualized ELAPE addressed the importance of personalized surgical procedure based on tumor stage and location, dedicating to avoid injury to vessels and nerves through preserving more surrounding tissues. Urogenital function outcomes, as part of postoperative outcomes, get more and more attention in recent years. We review current studies on urogenital function after ELAPE from anatomy to clinical research, in order to raise surgeons' attention of nerve preservation technique and to improve their understanding of ELAPE procedure.


Assuntos
Sistema Nervoso Autônomo/lesões , Traumatismos dos Nervos Periféricos/prevenção & controle , Protectomia/efeitos adversos , Protectomia/métodos , Neoplasias Retais/cirurgia , Sistema Urogenital/inervação , Sistema Nervoso Autônomo/cirurgia , Humanos , Diafragma da Pelve/lesões , Diafragma da Pelve/cirurgia , Períneo , Traumatismos dos Nervos Periféricos/etiologia , Protectomia/normas , Qualidade de Vida , Resultado do Tratamento , Sistema Urogenital/lesões , Sistema Urogenital/cirurgia
3.
Ann Vasc Surg ; 62: 70-75, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31207398

RESUMO

BACKGROUND: The objective of this study was to characterize phrenic nerve and brachial plexus variation encountered during supraclavicular decompression for neurogenic thoracic outlet syndrome and to identify associated postoperative neurologic complications. METHODS: A multicenter retrospective review was performed to evaluate anatomic variation of the phrenic nerve and brachial plexus from November 2010 to July 2018. After initial characterization, the following two groups were identified: variant anatomy (VA) group and standard anatomy (SA) group. Complications were analyzed and compared between the two groups. RESULTS: In total, 105 patients were identified, and 100 patients met inclusion criteria. Any anatomic variation of the standard course or configuration of the phrenic nerve and/or brachial plexus was encountered in 47 (47%) patients. Phrenic nerve anatomic variations were identified in 28 (28%) patients. These included 9 duplicated nerves, 6 lateral accessory nerves, 8 medial displacement, and 5 lateral displacement. Brachial plexus anatomic variation was found in 34 (34%) patients. The most common variant configuration of a fused middle and inferior trunk was identified in 25 (25%) patients. Combined phrenic nerve and brachial plexus anatomic variation was demonstrated in 15 (15%) patients. The VA and SA groups consisted of 47 and 53 patients, respectively. Transient phrenic nerve injury with postoperative elevation of the ipsilateral hemidiaphragm was documented in 3 (6.4%) patients in the VA group and 6 (11.3%) patients in the SA group (P = 0.49). Permanent phrenic nerve injury was identified in 1 (2.1%) patient in the VA group (P = 0.47) and none in the SA group. Transient brachial plexopathy was encountered in 1 (1.9%) patient in the SA group (P = 1.0) with full recovery to normal function. CONCLUSIONS: Anatomic variability of the phrenic nerve and brachial plexus are encountered more frequently than previously reported. While the incidence of nerve injury is low, surgeons operating within the thoracic aperture should be familiar with variant anatomy to reduce postoperative complications.


Assuntos
Neuropatias do Plexo Braquial/etiologia , Plexo Braquial/anormalidades , Descompressão Cirúrgica/efeitos adversos , Traumatismos dos Nervos Periféricos/etiologia , Nervo Frênico/anormalidades , Síndrome do Desfiladeiro Torácico/cirurgia , Adulto , Plexo Braquial/lesões , Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Humanos , Masculino , Maryland , Traumatismos dos Nervos Periféricos/fisiopatologia , Philadelphia , Nervo Frênico/lesões , Nervo Frênico/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/fisiopatologia , Resultado do Tratamento
4.
J Hand Surg Asian Pac Vol ; 24(4): 392-399, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690191

RESUMO

Background: The aim of this study was to identify the risk factors for median nerve dysfunctions after volar locking plate (VLP) fixation for distal radius fracture (DRF). Methods: We prospectively assessed the incidence of median nerve symptoms (MNS) such as numbness, pain, paresthesia, or hypesthesia in the area innervated by the median nerve and evaluated post-operative nerve conduction (NC) in 91 hands of 121 patients after VLP fixation for DRF. Multivariate logistic regression analysis was conducted to identify factors independently associated with MNS and abnormal NC in the injured wrist. Results: There were 18 cases (20%) of MNS on the injured side, 9 hands (10%) of both MNS and abnormal NC, 11 hands (12%) with only abnormal NC, and 9 hands with only MNS. Sensitivity, specificity, and diagnostic accuracy of abnormal NC for diagnosing MNS were 50%, 86%, and 78%, respectively. Four cases did not respond to conservative treatment and received carpal tunnel release concomitantly with plate removal. Logistic regression examination revealed that volar placement of the plate and short stature were significant independent predictors of MNS, while patient age was the sole independent predictor of abnormal NC. Conclusions: Our study demonstrated that plate prominence, short stature, and age were significant independent risk factors for median nerve dysfunctions after VLP fixation for DRF.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Nervo Mediano/fisiopatologia , Traumatismos dos Nervos Periféricos/diagnóstico , Fraturas do Rádio/complicações , Idoso , Eletromiografia , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Nervo Mediano/lesões , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/epidemiologia , Traumatismos dos Nervos Periféricos/etiologia , Complicações Pós-Operatórias , Estudos Prospectivos , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/cirurgia
5.
J Hand Surg Asian Pac Vol ; 24(4): 477-482, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690192

RESUMO

Background: It may be difficult to diagnose a nerve injury on a finger or a hand under emergency settings. The goal of this study was to elaborate whether the clinical testing of two-point discrimination was a safe and reliable method in the diagnosis of acute finger nerve injuries. Methods: Through a retrospective assessment, patients' records were analyzed whether the result of the two-point discrimination test corresponded with the intraoperative findings of a damaged nerve. Patients with a prolonged or missing two-point discrimination, who had undergone surgery at our institution between the years 2008 and 2017, were included in the study. The control groups were identified in the same manner and as an additional group, patients with Dupuytren's contracture were included to serve as a healthy cohort regarding finger nerves. Results: A total of 249 patients with nerve lesion were enrolled in the study; apart from this, 25 patients with Dupuytren's contracture were included. The sensitivity of the two-point discrimination test was 99%, with a positive predictive value of 0.93 and with high inter-observer reliability. Conclusions: The two-point discrimination is a valid test to use in the routine examination of suspected nerve injuries on the hands and fingers; it is very reliable and safe for indicating surgical interventions.


Assuntos
Dedos/inervação , Imagem Tridimensional , Traumatismos dos Nervos Periféricos/cirurgia , Adolescente , Feminino , Humanos , Osteotomia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Radiografia , Reprodutibilidade dos Testes , Ulna/cirurgia , Fraturas da Ulna/complicações
6.
J Hand Surg Asian Pac Vol ; 24(4): 494-497, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690196

RESUMO

A 49-year-old female patient with carpal tunnel syndrome at both hands was performed open carpal tunnel release. 4 months later, on the left hand, severance of the thenar branch was found by electromyography. On the 138th day, re-exploration was performed for direct nerve repair. During exploration, we identified the transligamentous variation of recurrent motor branch. Direct nerve repair was successful. At 6 months after direct repair, the nerve function began to return. At 2 years after direct repair, the nerve function has almost returned. There are some variations on the recurrent motor branch. And we overlooked transligamentous variation when we perform more decompression around the median nerve. It is important that recognize variations of thenar branch when we perform carpal tunnel release for not occurrence of severance of thenar branch.


Assuntos
Síndrome do Túnel Carpal/cirurgia , Descompressão Cirúrgica/métodos , Nervo Mediano/lesões , Traumatismos dos Nervos Periféricos/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Eletromiografia , Feminino , Seguimentos , Humanos , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/etiologia , Fatores de Tempo
7.
Acta Chir Orthop Traumatol Cech ; 86(5): 348-352, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748110

RESUMO

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posteriormuscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longustendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. Key words: nerve lesion, tendon transfer, acetabulum, pelvis, fracture.


Assuntos
Fraturas Ósseas/complicações , Traumatismos da Perna/cirurgia , Paraplegia/cirurgia , Ossos Pélvicos/lesões , Traumatismos dos Nervos Periféricos/cirurgia , Transferência Tendinosa/métodos , Acetábulo/lesões , Atividades Cotidianas , Adulto , Idoso , Humanos , Plexo Lombossacral/lesões , Pessoa de Meia-Idade , Mononeuropatias/etiologia , Mononeuropatias/cirurgia , Músculo Esquelético/inervação , Músculo Esquelético/transplante , Paraplegia/etiologia , Traumatismos dos Nervos Periféricos/etiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos
8.
Unfallchirurg ; 122(11): 860-863, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31712851

RESUMO

A small portion of patients suffer from severe knee pain following previous knee surgery or a trauma. Awareness among traumatologists regarding a neuropathic origin of this persistent knee pain is poor. Ongoing pain close to the knee may be caused by damage of the infrapatellar nerve (IN). This branch of the saphenous nerve is purely sensory and is at risk for iatrogenic damage due to its superficial medial course. Once recognized using simple tests during physical examination, a variety of treatment modalities may be proposed. However, a standard treatment algorithm was hitherto absent. This study includes 15 patients having IN damage who were offered a step-up regimen including lidocaine injections, pulsed radiofrequency (PRF) or neurectomy. Success (>50% drop in numeric rating scale pain score) was attained in 11 (73% success rate, 9 month median follow-up). The aim of this contribution is to increase knowledge regarding this illusive entity and to discuss the efficacy of our treatment protocol.


Assuntos
Nervo Femoral/lesões , Dor/etiologia , Traumatismos dos Nervos Periféricos/terapia , Denervação , Humanos , Perna (Membro)/inervação , Dor/diagnóstico , Manejo da Dor , Medição da Dor , Traumatismos dos Nervos Periféricos/etiologia , Resultado do Tratamento
9.
Medicine (Baltimore) ; 98(42): e17611, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626138

RESUMO

There is no consensus regarding the references to determine the exact location of the skin incision to minimize iatrogenic sural nerve injury in the sinus tarsi approach for calcaneal fracture.The purpose of this cadaveric study was to describe the anatomical course of the sural nerve in relation to easily identifiable landmarks during the sinus tarsi approach and to provide a more practical reference for surgeons to avoid sural nerve injury.Twenty-four foot and ankle specimens were dissected. The bony landmarks used in the following reference points were the tip of the lateral malleolus (point A), lateral border of the Achilles tendon on the collinear line with point A (point B), posteroinferior apex of the calcaneus (point C), inferior margin of the calcaneus on the plumb line through point A (point D), and tip of the fifth metatarsal base (point E). After careful dissection, the distances of the sural nerve to points A and B in the horizontal direction (lines D1 and D2), points A and C in the diagonal direction (lines D3 and D4), points A and D in the vertical direction (lines D5 and D6), and points A and E in the diagonal direction (lines D7 and D8) were measured.The median ratio of D1 to D1+D2, D3 to D3+D4, D5 to D5+D6, and D7 to D7+D8 were 0.37 (range, 0.26-0.50), 0.23 (range, 016-0.33), 0.35 (range, 0.25-0.45), and 0.32 (range, 0.20-0.45), respectively.The distance ratios from this study can be helpful to avoid sural nerve injury during the sinus tarsi approach for calcaneal fractures. Established standard incision may have to be modified to minimize sural nerve injury.


Assuntos
Traumatismos do Tornozelo/cirurgia , Calcâneo/lesões , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Complicações Intraoperatórias/prevenção & controle , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervo Sural/lesões , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Tornozelo/diagnóstico , Cadáver , Calcâneo/cirurgia , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Ossos do Tarso/cirurgia
10.
J Pediatr Orthop ; 39(9): e652-e656, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503220

RESUMO

BACKGROUND: Nerve injuries occur in approximately 11% of pediatric extension supracondylar humerus fractures (SCHF), yet there is scarce literature to guide clinicians on management. The primary goal of this study was to report the presentation, treatment, and outcome of motor nerve injuries associated with extension SCHF. Our secondary goal was to determine which injury and treatment factors were associated with prolonged motor nerve recovery. METHODS: Two hundred forty-four traumatic nerve injuries associated with extension SCHF treated at a single institution between 1996 and 2012 were reviewed. Patients with iatrogenic nerve injuries or subjective paresthesias without motor deficit were excluded. Univariable and multivariable general linear modeling were used to compare recovery times across nerve injury types and to determine the effect of injury and treatment characteristics on recovery time. RESULTS: Patients were a mean age of 6.7 years, with 89% presenting with a single nerve injury and 29% of the cohort experiencing a concurrent vascular injury. The majority of injuries (62%) were to the median nerve. Forty-three (18%) cases had acute nerve decompression at the time of fracture fixation. Five cases required subsequent surgery for poor nerve recovery; none of which underwent initial nerve decompression. Thirty-one patients were lost to follow-up after injury. Median time to nerve recovery was 2.3 months (IQR 1.4 to 3.7 mo); 60% of injuries had nerve recovery by 3 months and 196 (92%) patients had complete nerve recovery at final follow-up. A greater percentage of isolated median nerve (70%) injuries recovered within 3 months compared with radial nerve (42%) injuries (P=0.01). Multivariable analysis demonstrated that multiple nerve injuries took 54% longer to recover than single median nerve injuries (P=0.01), and single radial nerve injuries took 30% longer to recover than single median nerve injuries (P=0.04). CONCLUSIONS: The majority of nerve injuries associated with pediatric extension SCHF recover within 6 months without acute nerve decompression. The presence of either an isolated radial nerve injury or multiple nerve injuries is associated with prolonged motor recovery. LEVEL OF EVIDENCE: Level IV.


Assuntos
Fraturas do Úmero/complicações , Nervo Mediano/lesões , Traumatismos dos Nervos Periféricos/etiologia , Nervo Radial/lesões , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Fixação de Fratura , Humanos , Fraturas do Úmero/cirurgia , Úmero/lesões , Traumatismo Múltiplo , Estudos Retrospectivos , Traumatismos do Sistema Nervoso , Lesões do Sistema Vascular
11.
Chin J Traumatol ; 22(5): 249-254, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31492575

RESUMO

PURPOSE: Supracondylar fractures of the humerus cause significant morbidity in children. Nerve damage and loss of fracture reduction are common recognised complications in patients with this injury. Uncertainty surrounds the optimal Kirschner wire configuration and diameter for closed reduction and pinning of these fractures. This study describes current practice and examined the association between wire configuration or diameter and outcomes (clinical and radiological) in the operative management of paediatric supracondylar fractures. METHODS: Children presenting with Gartland II or III supracondylar fractures at five hospitals in south-west England were eligible for inclusion. Collaborators scrutinised paper and electronic case notes. Outcome measures were maintenance of reduction and iatrogenic nerve injury. RESULTS: Altogether 209 patients were eligible for inclusion: 15.7% had a documented neurological deficit at presentation; 3.9% who were neurologically intact at presentation sustained a new deficit caused by treatment and 13.4% experienced a clinically significant loss of reduction following fixation. Maintenance of reduction was significantly better in patients treated specifically with crossed ×3 Kirschner wire configuration compared to all other configurations. The incidence of iatrogenic nerve injury was not significantly different between groups treated with different wire configurations. CONCLUSION: We present a large multicentre cohort study showing that crossed ×3 Kirschner wires are associated with better maintenance of reduction than crossed ×2 or lateral entry wires. Greater numbers would be required to properly investigate nerve injury relating to operative management of supracondylar fractures. We found significant variations in practice and compliance with the British Orthopaedic Association Standard for Trauma (BOAST) 11 guidelines.


Assuntos
Fios Ortopédicos , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Úmero/cirurgia , Criança , Estudos de Coortes , Inglaterra , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Doença Iatrogênica , Masculino , Traumatismos dos Nervos Periféricos/etiologia , Estudos Retrospectivos
12.
Sports Health ; 11(6): 550-553, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484001

RESUMO

An elite high school American football athlete sustained a traumatic, isolated, axillary nerve injury. Axillary nerve injuries are uncommon, but serious injuries in American football. With the advent of nerve transfers and grafts, these injuries, if diagnosed in a timely manner, are treatable. This case report discusses the multidisciplinary approach necessary for the diagnosis and treatment of an elite high school American football player who presented with marked deltoid atrophy. The athlete's injury was diagnosed via electrodiagnostic testing and he underwent a medial triceps nerve to axillary nerve transfer. After appropriate postsurgical therapy, the athlete was able to return to American football the subsequent season and continue performing at an elite level. This case report reviews the evaluation and modern treatment for axillary nerve injuries in the athlete, including nerve transfers, nerve grafts, and return to play.


Assuntos
Axila/inervação , Futebol Americano/lesões , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/cirurgia , Adolescente , Diagnóstico Tardio , Eletromiografia , Humanos , Imagem por Ressonância Magnética , Masculino , Debilidade Muscular/etiologia , Atrofia Muscular/etiologia , Transferência de Nervo/métodos , Traumatismos dos Nervos Periféricos/etiologia , Volta ao Esporte
13.
Curr Opin Anaesthesiol ; 32(5): 638-642, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31415044

RESUMO

PURPOSE OF REVIEW: Summarize the current thinking concerning the clinically relevant aspects of nerve anatomy and best injection sites for nerve blocks. RECENT FINDINGS: The widespread use of ultrasound in regional anesthesia has changed the practice of regional anesthesia and created new possibilities. Among them is the ability to identify fascial planes, and this has become the basis for a new group of blocks, the fascial plane blocks. In this kind of blocks, the target for injection is the plane itself and not a nerve in particular. transversus abdominis plane, pectoralis muscles, erector spinae plane blocks are some examples of fascial blocks. Because injecting into a fascial plane is not controversial, these blocks are not included in our discussion of optimal placement of the needle.To determine optimal needle placement, it is important to have a clear definition of what constitutes intraneural. Although, there is almost universal agreement that the violation of the epineurium defines the intraneural concept, the literature include several studies where this assessment is erroneous.Although intentional intraneural injection is still considered objectionable, some literature suggests that injecting intraneurally, especially if extrafascicular, may be benign. This evidence is limited and anecdotal. SUMMARY: It is necessary to have a better understanding of what intraneural injection is when dealing with any type of nerve blocks, be that single nerve, plexuses, or the sciatic nerve. Perineural injections provide successful anesthesia without putting the nerve integrity at risk. That practice is supported by years of experience and common sense. Currently, there is no evidence to support any kind of intraneural injections, intrafascicular or extrafascicular.


Assuntos
Agulhas/efeitos adversos , Bloqueio Nervoso/métodos , Traumatismos dos Nervos Periféricos/prevenção & controle , Nervos Periféricos/anatomia & histologia , Humanos , Injeções/efeitos adversos , Injeções/instrumentação , Injeções/métodos , Bloqueio Nervoso/efeitos adversos , Bloqueio Nervoso/instrumentação , Traumatismos dos Nervos Periféricos/etiologia , Nervos Periféricos/diagnóstico por imagem , Ultrassonografia de Intervenção
14.
Best Pract Res Clin Anaesthesiol ; 33(1): 47-56, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31272653

RESUMO

Nerve injury is a relatively rare but devastating complication of peripheral nerve blockade (PNB). Monitoring injection pressure during PNB is one method advocated to prevent injury by detecting needle tip placement in a noncompliant position (intraneural or abutting the epineurium). Animal studies show that gross neural damage and clinical injury are associated with injection pressures exceeding 15-20 psi. In contrast, pressures <15 psi are associated with an extraneural needle tip position and no histologic or clinical injury. Injection pressure monitoring has been shown to prevent injection against the brachial plexus roots or femoral nerve during peripheral nerve block. Multiple methods are available to monitor injection pressure, and most of them are inexpensive and easy to use. Large-scale registry database or pragmatic trials are indicated to show that injection pressure monitoring reduces injury in a patient setting.


Assuntos
Reação no Local da Injeção/patologia , Monitorização Intraoperatória/métodos , Bloqueio Nervoso/efeitos adversos , Traumatismos dos Nervos Periféricos/patologia , Humanos , Reação no Local da Injeção/etiologia , Reação no Local da Injeção/prevenção & controle , Injeções/efeitos adversos , Bloqueio Nervoso/instrumentação , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Pressão/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos , Ultrassonografia de Intervenção/métodos
15.
Orthopedics ; 42(4): e395-e398, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31323111

RESUMO

Proximal humerus fractures in elderly patients are a common injury that can often be treated nonoperatively. However, surgery is indicated with some fracture patterns. Arthroplasty is an attractive option with poor bone quality, when there is a low likelihood of success with open reduction and internal fixation, and due to a timely return to function and weight bearing of the extremity in this patient population. A prerequisite for shoulder function for both native and replacement joints is a functional deltoid. Unfortunately, elderly patients with complex fracture patterns can sustain axillary nerve palsies that make management more difficult. The authors present a case of an elderly patient with a complex fracture-dislocation of the proximal humerus with traumatic axillary nerve palsy treated with hemiarthroplasty, followed by radial-to-axillary nerve transfer after the deltoid failed to improve. Congruency of the joint was restored and significant improvement in objective scoring metrics was achieved, making nerve transfer in this clinical scenario a viable option. [Orthopedics. 2019; 42(4):e395-e398.].


Assuntos
Fratura-Luxação/complicações , Hemiartroplastia , Transferência de Nervo/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Nervo Radial/transplante , Fraturas do Ombro/complicações , Ombro/cirurgia , Idoso , Feminino , Fratura-Luxação/cirurgia , Humanos , Úmero/cirurgia , Traumatismos dos Nervos Periféricos/etiologia , Fraturas do Ombro/cirurgia , Resultado do Tratamento
16.
Eur Arch Otorhinolaryngol ; 276(11): 3185-3193, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31338575

RESUMO

PURPOSE: Periauricular sensory deficit occurs frequently after parotidectomy even in cases with preservation of the greater auricular nerve (GAN). This study was performed to evaluate the effects of antiadhesive agent in functional recovery of the GAN after parotidectomy. METHODS: Ninety-eight patients undergoing partial parotidectomy for benign parotid tumors were prospectively enrolled in this multicenter, double-blind randomized controlled study and randomly assigned to either the study or control group. Antiadhesive agent was applied in the study group. The results of sensory tests (tactile, heat, and cold sensitivity) and a questionnaire on quality of life (QoL) were acquired at postoperative 1, 8, and 24 weeks after surgery. Clinical parameters, and the results of the sensory tests and the questionnaire, were compared between the two groups. RESULTS: A total of 80 patients were finally enrolled. On sensory evaluation, tactile sensation and warm sensation in the ear lobule, and warm sensation in the mastoid area, showed significant improvement at 24 weeks postoperatively in the study group. There were no significant differences between the two groups on any questions in the QoL questionnaire, at any follow-up time point. CONCLUSIONS: Antiadhesive agents have some positive effects on functional recovery of the GAN after parotidectomy. Therefore, applying antiadhesive agents after parotidectomy can reduce discomfort in patients.


Assuntos
Agnosia , Plexo Cervical/lesões , Dissecação , Glândula Parótida/cirurgia , Neoplasias Parotídeas/cirurgia , Traumatismos dos Nervos Periféricos , Aderências Teciduais , Agnosia/diagnóstico , Agnosia/etiologia , Agnosia/terapia , Dissecação/efeitos adversos , Dissecação/métodos , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glândula Parótida/patologia , Neoplasias Parotídeas/patologia , Região Parotídea/inervação , Região Parotídea/cirurgia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/terapia , Recuperação de Função Fisiológica/fisiologia , Aderências Teciduais/etiologia , Aderências Teciduais/prevenção & controle , Resultado do Tratamento
17.
Diagn Interv Radiol ; 25(5): 380-391, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31310240

RESUMO

Although peripheral nerve injuries secondary to angiography and endovascular interventions are uncommon and usually not permanent, they can result in significant functional impairment. Most arteries used in access for angiography and endovascular therapies lie in close proximity to a nerve. The nerve may be injured by needle puncture, or by compression from hematoma, pseudoaneurysm, hemostasis devices, or by manual compression with incidence in literature ranging from as low as 0.04% for femoral access in a large retrospective study to 9% for brachial and axillary access. Given the increasing frequency of endovascular arterial procedures and the increasing use of nontraditional access points, it is important that the interventionalist have a working knowledge of peripheral nerve anatomy and function as it relates to relevant arterial access sites to avoid injury.


Assuntos
Angiografia/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Traumatismos dos Nervos Periféricos/prevenção & controle , Humanos , Traumatismos dos Nervos Periféricos/etiologia , Punções , Fatores de Risco
18.
J Shoulder Elbow Surg ; 28(7): 1308-1315, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31230782

RESUMO

BACKGROUND: Iatrogenic supraclavicular nerve injury is frequent during surgical repair of clavicle fractures through a transverse incision. The use of an oblique incision may be a potential approach to avoiding this complication. This study compared the clinical effectiveness of oblique and transverse incisions in the treatment of fractures in the middle and outer thirds of the clavicle. METHODS: This prospective observational study included patients with fracture of the mid-to-outer third of the clavicle between August 2011 and August 2016. We allocated the patients into 2 groups based on their choice of treatment: oblique incision (n = 62) and transverse incision (n = 64). We compared the following parameters between the 2 groups: operative time, intraoperative blood loss, postoperative fracture healing time, incision size, clinical complications, postoperative subjective satisfaction, and shoulder function. RESULTS: Operative time, postoperative fracture healing time, postoperative shoulder function (Constant-Murley and disabilities of the arm, shoulder and hand [DASH] scores), and clinical complications did not differ significantly between groups (all P > .05). The oblique incision group had less intraoperative blood loss (41.4 ± 16.4 vs. 65.3 ± 10.4 mL, P < .001) and smaller surgical incisions (3.6 ± 1.6 vs. 10.3 ± 2.6 cm, P < .001). The oblique incision group showed better outcomes for postoperative satisfaction (85.5% vs. 64.1%, P = .015), absence of shoulder numbness at the last follow-up (89.3% vs. 70.3%, P = .010), and satisfaction with the scar (90.3% vs. 3.1%, P < .001). CONCLUSION: Oblique incisions have several advantages over transverse incisions: less bleeding, smaller incisions, less iatrogenic injury to supraclavicular nerves, and higher patient satisfaction. These 2 approaches have equivalent effects on recovery of shoulder joint function.


Assuntos
Clavícula/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Traumatismos dos Nervos Periféricos/prevenção & controle , Adulto , Perda Sanguínea Cirúrgica , Clavícula/lesões , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Satisfação do Paciente , Traumatismos dos Nervos Periféricos/etiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Estudos Prospectivos , Ombro/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
19.
J Pak Med Assoc ; 69(5): 672-676, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31105286

RESUMO

OBJECTIVE: To explore the pattern of electrodiagnostic findings in cases of wrist drop and compare gender, involved side of the body, and military versus civilian population for the aetiology of wrist drop. METHODS: This cross-sectional study was conducted at Armed Forces Institute of Rehabilitation Medicine Rawalpindi, Pakistan, from August 2013 to December 2014, and comprised wrist drop cases regardless of age or gender. Evaluation was done using XLTEK Neuromax 1004 EMG unit in line with the recommended protocol for electrodiagnostic evaluation of a suspected radial nerve injury(RNI). SPSS 20 was used for data analysis. RESULTS: Of the 119 patients, 97(81.5%) were males, 66(55.5%) were in the 16-30 years' age group, and 96(80.7%) were military personnel. RNI at the mid-arm level was the commonest cause in 88(73.9%) cases. The frequent inciting event was trauma with fracture of the humerus in 39(32.8%) cases. Eighty-four (70.6%) lesions were axonal. Ninety-four (79%) individuals had no associated injury to other nerves. Injuries due to trauma were more frequent in males (p<0.001), on the right side (p=0.046), and in the military population (p=0.05). CONCLUSIONS: RNI at the mid arm level was the commonest cause of wrist drop in our sample and fracture of the humerus was the main inciting event..


Assuntos
Fraturas Ósseas/complicações , Úmero/lesões , Doença Iatrogênica , Traumatismos dos Nervos Periféricos/etiologia , Nervo Radial/lesões , Neuropatia Radial/etiologia , Adolescente , Adulto , Eletrodiagnóstico , Eletromiografia , Feminino , Hospitais Militares , Humanos , Masculino , Nervo Mediano/lesões , Pessoa de Meia-Idade , Militares/estatística & dados numéricos , Condução Nervosa , Traumatismos dos Nervos Periféricos/diagnóstico , Neuropatia Radial/diagnóstico , Raízes Nervosas Espinhais/lesões , Nervo Ulnar/lesões , Adulto Jovem
20.
Eur J Orthop Surg Traumatol ; 29(6): 1169-1175, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31037406

RESUMO

Aim of this review article is to evaluate the percentage of ulnar nerve lesion during cross-pinning considering the patient's position (supine or prone) on the surgical bed. Comprehensive research was performed by searching in PUBMED, Cochrane Library, ISI Web of Science, SCOPUS and Clinicaltrials.gov from 2005. Children with extension type supracondylar humeral fractures without clinical signs of ulnar nerve lesion at presentation were included. A total of 28 papers were examined including 2147 patients; 1541 underwent a closed reduction and cross-pinning in supine position and 606 in prone position. Among 1541 patients in supine position, 69 (4.5%) suffered from a ulnar nerve injury while among the 606 patients treated in prone position none ulnar nerve lesions were reported. Despite the apparent safety of prone position, further larger studies, comparing the patient's position on the surgical bed, need to be carried out in order to confirm this likelihood.


Assuntos
Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/cirurgia , Complicações Intraoperatórias/prevenção & controle , Posicionamento do Paciente/métodos , Traumatismos dos Nervos Periféricos , Nervo Ulnar/lesões , Criança , Fixação Interna de Fraturas/métodos , Humanos , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/prevenção & controle , Risco Ajustado
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