Jayme Bertelli1, Francisco Soldado2, Marcos F Ghizoni3. 1. Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarinal, Brazil; Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil. 2. Pediatric Hand Surgery and Microsurgery Unit, Hospital Sant Joan de Deu; Universitat de Barcelona, Barcelona, Spain; Vithas San José Hospital, Vitoria, Spain. Electronic address: drsoldado@cirugiamanoinfantil.com. 3. Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão, Brazil.
Abstract
PURPOSE: To report the results of radial nerve grafting in 7 children who sustained a radial nerve injury following a distal humeral fracture. METHODS: Seven children, mean age 6 years (range, 4-11 years), underwent nerve grafting for radial nerve injuries following distal humeral fractures. The mean interval between injury and surgery was 6.7 months (range, 6-9 months). In all cases, 3 sural nerve graft cables were used, of mean length 8.6 cm (range, 6-12 cm). Mean follow-up was 19.9 months (range, 12-24 months). Wrist, finger, and thumb extension range of motion and strength were evaluated at final follow-up, using the British Medical Research Council (BMRC) rating scale. RESULTS: The radial nerve was entrapped within the fracture site in 2 patients, and in 5, it was completely interrupted without entrapment. All patients obtained full active wrist extension with grade M4 BMRC strength. For finger extension, all patients were graded as M4, obtaining full metacarpophalangeal finger and thumb extension, with the wrist in neutral in 3 patients and fully extended in 4. During the thumbs-up test, 4 patients achieved complete extension of all thumb joints, and 3 exhibited metacarpophalangeal extension lag, averaging 30°. CONCLUSIONS: Nerve grafting of radial nerve injuries at the level of the distal humerus in children can yield excellent outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
PURPOSE: To report the results of radial nerve grafting in 7 children who sustained a radial nerve injury following a distal humeral fracture. METHODS: Seven children, mean age 6 years (range, 4-11 years), underwent nerve grafting for radial nerve injuries following distal humeral fractures. The mean interval between injury and surgery was 6.7 months (range, 6-9 months). In all cases, 3 sural nerve graft cables were used, of mean length 8.6 cm (range, 6-12 cm). Mean follow-up was 19.9 months (range, 12-24 months). Wrist, finger, and thumb extension range of motion and strength were evaluated at final follow-up, using the British Medical Research Council (BMRC) rating scale. RESULTS: The radial nerve was entrapped within the fracture site in 2 patients, and in 5, it was completely interrupted without entrapment. All patients obtained full active wrist extension with grade M4 BMRC strength. For finger extension, all patients were graded as M4, obtaining full metacarpophalangeal finger and thumb extension, with the wrist in neutral in 3 patients and fully extended in 4. During the thumbs-up test, 4 patients achieved complete extension of all thumb joints, and 3 exhibited metacarpophalangeal extension lag, averaging 30°. CONCLUSIONS: Nerve grafting of radial nerve injuries at the level of the distal humerus in children can yield excellent outcomes. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
Authors: Nunzio Catena; Giovanni Luigi Di Gennaro; Andrea Jester; Sergio Martínez-Alvarez; Eva Pontén; Francisco Soldado; Christina Steiger; Jiahui Choong; Paola Zarantonello; Sebastian Farr Journal: J Child Orthop Date: 2021-04-19 Impact factor: 1.548