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Iatrogenic nerve injuries: a potentially serious medical and medicolegal problem. About a series of 42 patients and review of the literature

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Abstract

Objective

To analyze the management of iatrogenic nerve injuries (iNI) in 42 patients.

Methods

Retrospective analysis of the charts.

Results

The iNI occurred mostly during a surgical procedure (n = 39), either on a nerve or plexus (n = 13), on bone, joint, vessel or soft tissue (n = 24) or because of malpositioning (n = 2). The most commonly injured nerves were the brachial plexus, radial, sciatic, femoral, or peroneal nerves. 42.9% of the patients were referred later than 6 months. A neurological deficit was present in 37 patients and neuropathic pain in 17. Two patients were lost to follow-up. Conservative treatment was applied in 23 patients because of good spontaneous recovery or compensation or because of expected bad prognosis whatever the treatment. Surgical treatment was performed in 17 patients because of known nerve section (n = 2), persistent neurological deficit (n = 12) or invalidating neuropathic pain (n = 3); nerve reconstruction with grafts (n = 8) and neurolysis (n = 8) were the most common procedures. Outcome was satisfactory in 50%. Potential reasons of poor outcome were a very proximal injury, placement of very long grafts, delayed referral and predominance of neuropathic pain. According to the literature delayed referral of iNI for treatment is frequent. We provide an illustrative case of a young girl operated on at 6.5 months for femoral nerve reconstruction with grafts while nerve section was obvious from the operative note and pathological tissue analysis. Litigation claims (n = 10) resulted in malpractice (n = 2) or therapeutic alea (n = 5) (3 unavailable conclusions). i

Conclusions

NI can result in considerable disability, pain and litigation. Optimal management is required.

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Authors and Affiliations

  1. Department of Neurosurgery, CHU Liège, Liège, Belgium

    Annie Dubuisson, Bruno Kaschten, Maximilien Steinmetz, François Gérardy, Arnaud Lombard, Quentin Dewandre & Gilles Reuter

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  1. Annie Dubuisson
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  2. Bruno Kaschten
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  3. Maximilien Steinmetz
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  4. François Gérardy
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  5. Arnaud Lombard
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  6. Quentin Dewandre
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  7. Gilles Reuter
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Correspondence to Annie Dubuisson.

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The authors declare that they have no conflict of interest.

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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Dubuisson, A., Kaschten, B., Steinmetz, M. et al. Iatrogenic nerve injuries: a potentially serious medical and medicolegal problem. About a series of 42 patients and review of the literature. Acta Neurol Belg 121, 119–124 (2021). https://doi.org/10.1007/s13760-020-01424-0

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  • DOI: https://doi.org/10.1007/s13760-020-01424-0

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