Skip to main content

Advertisement

SpringerLink
Log in

Treatment of upper extremity nerve defects by direct suturing in high elbow or wrist flexion

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To evaluate functional outcomes after direct suturing of upper extremity nerve defects in high elbow or wrist flexion.

Methods

A retrospective review was conducted in patients treated for median, ulnar, or radial nerve defects between 2011 and 2019. Inclusion criteria were a defect > 1 cm and a minimal follow-up period of 1 year. Nerve defects were bridged by an end-to-end suture in 90° elbow flexion or 70° wrist flexion for 6 weeks.

Results

Nine patients with a mean age of 30.2 years were included. The patients presented with two ulnar nerve defects, four median nerve defects, and three radial nerve defects at various levels. The mean time to surgery was 13.5 weeks for recent injuries. The mean defect length was 2.9 cm, and the mean follow-up time was 22.4 months. Two patients had joint stiffness that was more likely related to the associated injuries than the 6-week immobilization. Successful outcomes were achieved in eight of the nine patients. Meaningful motor recovery was observed in seven patients, and all recovered meaningful sensation. Excellent nerve recovery was noted in pediatric patients and in those with distal nerve defects.

Conclusion

Temporary high joint flexion allows for direct coaptation of upper extremity nerve defects up to 4 cm located near the elbow or wrist. In this small and heterogenous cohort, functional outcomes seemed to be comparable to those obtained with short autografting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Griffin JW, Hogan MV, Chhabra AB, Deal DN. Peripheral nerve repair and reconstruction. J Bone Joint Surg Am. 2013;95:2144–55.

    Article  PubMed  Google Scholar 

  2. Boyd KU, Fox IK. Nerve repair and grafting. In: Mackinnon SE, editor. Nerve surgery. New York: Thieme Medical Publishers; 2015. p. 75–100.

    Google Scholar 

  3. Millesi H. The interfascicular nerve grafting of the median and the ulnar nerves. J Bone Joint Surg Am. 1972;54:727–50.

    Article  CAS  PubMed  Google Scholar 

  4. Driscoll PJ, Glasby MA, Lawson GM. An in vivo study of peripheral nerves in continuity: biomechanical and physiological responses to elongation. J Orthop Res. 2002;20:370–5.

    Article  PubMed  Google Scholar 

  5. Mathieu L, Pfister G, Murison JC, Oberlin C, Belkheyar Z. Missile injury of the sciatic nerve: observational study supporting early exploration and direct suture with flexed knee. Mil Med. 2019;184:e937–44.

    Article  PubMed  Google Scholar 

  6. Mathieu L, Addas BMJ, Irimura SC, Oberlin C, Belkheyar Z. Management of sciatic nerve defects: lessons learned and proposal for a new strategy. Ann Plast Surg. 2020;84:559–64.

    Article  CAS  PubMed  Google Scholar 

  7. Bourrel P. Favorable results of sciatic nerve suturing performed 15 months after sectioning. Value of repeated exploratory surgery 2 months after the suturing. Mars Chir. 1965;175:203–8.

    Google Scholar 

  8. Bourrel P, De Bisschop G. Suture of the sciatic nerve performed 15 months after its section. Result 2 years later. Value of repeated exploration. Ann Chir. 1966;20:1145–9.

    CAS  PubMed  Google Scholar 

  9. Oberlin C, Rantissi M. Gunshot injuries to the nerves. Chir Main. 2011;30:176–82.

    Article  CAS  PubMed  Google Scholar 

  10. Pfister G, Ghabi A, de Carbonnières A, Oberlin C, Belkheyar Z, Mathieu L. Direct suturing of sciatic nerve defects in high-degree knee flexion: an experimental study. World Neurosurg. 2020;133:e288–92.

    Article  PubMed  Google Scholar 

  11. Mathieu L, Goncalves M, Murison JC, Pfister G, Oberlin C, Belkheyar Z. Ballistic peripheral nerve injuries: basic concepts, controversies, and proposal for a management strategy. Eur J Trauma Emerg Surg. 2022. https://doi.org/10.1007/s00068-022-01929-8.

    Article  PubMed  Google Scholar 

  12. Roganovic Z. Missile-caused ulnar nerve injuries: outcomes of 128 repairs. Neurosurgery. 2004;55:1120–9.

    Article  PubMed  Google Scholar 

  13. Roganovic Z. Missile-caused median nerve injuries: results of 81 repairs. Surg Neurol. 2005;63:410–8.

    Article  PubMed  Google Scholar 

  14. Trumble TE. Overcoming defects in peripheral nerves. In: Gelberman RH, editor. Operative nerve repair and reconstruction. 1st ed. Philadelphia: JB Lippincott; 1991. p. 507–23.

    Google Scholar 

  15. Abrams RA, Fenichel AS, Callahan JJ, Brown RA, Botte MJ, Lieber RL. The role of ulnar nerve transposition in ulnar nerve repair: a cadaver study. J Hand Surg. 1998;23A:244–9.

    Article  Google Scholar 

  16. Choudhry IK, Bracey DN, Hutchinson ID, Li Z. Comparison of transposition techniques to reduce gap associated with high ulnar nerve lesions. J Hand Surg Am. 2014;39:2460–3.

    Article  PubMed  Google Scholar 

  17. Smetana BS, Jernigan EW, Rummings WA Jr, Weinhold PS, Draeger RW, Patterson MM. Submuscular versus subcutaneous ulnar nerve transposition: a cadaveric model evaluating their role in primary ulnar nerve repair at the elbow. J Hand Surg Am. 2017;42(571):e1-7.

    Google Scholar 

  18. Kitta MI, Ariandi M, Nugroho YA, Nur A, Arden F. Neurological recovery across a 2-cm gap of radial nerve using end to end suture following supracondylar humerus fracture: case report. Int J Surg Case Rep. 2021. https://doi.org/10.1016/j.ijscr.2021.105896.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Medical research council of the United Kingdom. Aids to the examination of peripheral nervous system. Memorandum No. 45, London, Her Majesty’s Stationery Office, 1976.

  20. Kim DH, Kam AC, Chandika P. Surgical management and outcomes in patients with median nerve lesions. J Neurosurg. 2001;95:584–94.

    Article  CAS  PubMed  Google Scholar 

  21. Kim DH, Kam AC, Chandika P, Tiel RL, Kline DG. Surgical management and outcome in patients with radial nerve lesions. J Neurosurg. 2001;95:573–83.

    Article  CAS  PubMed  Google Scholar 

  22. Kim DH, Han K, Tiel RL, Murovic JA, Kline DG. Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg. 2003;98:993–1004.

    Article  PubMed  Google Scholar 

  23. Birch R, Raji ARM. Repair of median and ulnar nerves. J Bone Joint Surg Br. 1991;73:154–7.

    Article  CAS  PubMed  Google Scholar 

  24. Murovic JA. Upper-extremity peripheral nerve injuries: a Louisiana State University Health Sciences Center literature review with comparison of the operative outcomes of 1837 Louisiana State University Health Sciences Center median, radial, and ulnar nerve lesions. Neurosurgery. 2009;65:A11–7.

    Article  PubMed  Google Scholar 

  25. Ruijs AC, Jaquet JB, Kalmijn S, Giele H, Hovius SER. Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg. 2005;116:495–6.

    Article  Google Scholar 

  26. Pan CH, Chuang DCC, Rodríguez-Lorenzo A. Outcomes of nerve reconstruction for radial nerve injuries based on the level of injury in 244 operative cases. J Hand Surg Eur. 2010;35:385–91.

    Article  Google Scholar 

  27. Ramachandran M, Birch R, Eastwood DM. Clinical outcome of nerve injuries associated with supracondylar fractures of the humerus in children. The experience of a specialist referral centre. J Bone Joint Surg [Br]. 2006;88B:90–4.

    Article  Google Scholar 

  28. Kwok IHY, Silk ZM, Quick TJ, Sinisi M, MacQuillan A, Fox M. Nerve injuries associated with supracondylar fractures of the humerus in children. Our experience in a specialist peripheral nerve injury unit. Bone Joint J. 2016;98-B:851–6.

    Article  CAS  PubMed  Google Scholar 

  29. Hagemann C, Harhaus L. Combined distal nerve and tendon transfer in drop wrist for treatment of high injuries of the radial nerve. Oper Orthop Traumatol. 2021;33:399–404.

    Article  PubMed  Google Scholar 

  30. Acciari N, Davalli C, Poppi M, Scoto S, Staffa G. Interruption of the radial nerve at proximal level: reconstruction following anterior transposition. Chir Organi Mov. 1998;83:435–40.

    Google Scholar 

Download references

Funding

No source of funding.

Author information

Authors and Affiliations

  1. Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France

    Laurent Mathieu, Constance Diner, Anaïs Chataigneau & Georges Pfister

  2. French Military Hand Surgery Center, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France

    Laurent Mathieu, Constance Diner, Anaïs Chataigneau & Georges Pfister

  3. Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 place Alphonse Laveran, 75005, Paris, France

    Laurent Mathieu

  4. Military Biomedical Research Institute (IRBA), 1 place Général Valérie André, 91220, Brétigny-sur-Orge, France

    Laurent Mathieu

  5. Nerve and Brachial Plexus Surgery Unit, Mont-Louis Private Hospital, 8 rue de la Folie Regnault, 75011, Paris, France

    Christophe Oberlin & Zoubir Belkheyar

Authors
  1. Laurent Mathieu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Constance Diner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anaïs Chataigneau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georges Pfister
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christophe Oberlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zoubir Belkheyar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laurent Mathieu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mathieu, L., Diner, C., Chataigneau, A. et al. Treatment of upper extremity nerve defects by direct suturing in high elbow or wrist flexion. Eur J Trauma Emerg Surg 48, 4661–4667 (2022). https://doi.org/10.1007/s00068-022-01986-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-022-01986-z

Keywords

Search

Navigation