Child's Nervous System

, Volume 35, Issue 1, pp 29–35 | Cite as

Peripheral nerve injuries in the pediatric population: a review of the literature. Part I: traumatic nerve injuries

  • Javier Robla Costales
  • Mariano SocolovskyEmail author
  • Jaime A. Sánchez Lázaro
  • Rubén Álvarez García
Review Paper



This article reviews the clinical results that can be obtained after repair of a traumatic peripheral nerve injury in the pediatric population.


A systematic review of the published literature has been made.


Functional outcome after major nerve injuries is sometimes disappointing in adults. However, children have been reported to experience much better functional results after nerve repair than adults. Moreover, recovery generally is faster in children. The superior capacity of children’s central nervous system to adapt to external or internal environmental changes (neural plasticity) and the shorter recovery distance from the axon repair site to the target muscle are claimed to be crucial determinants of their favorable outcomes. Moreover, even in the pediatric population, it has been demonstrated that functional results are better the younger the patient is, including better clinical results in those injured in early childhood (< 6 years old) than in those injured in adolescence. Other favorable prognostic factors include the type of nerve injury (with complete transections doing less well than crush injuries) and the timing of surgery (with better outcomes after early repairs).


All efforts should be done to repair in a timely and adequate fashion traumatic peripheral nerve injuries in children, as the results are good.


Peripheral nerve injury Pediatric patients Nerve section Traumatic nerve lesion 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Birch R, Achan P (2000) Peripheral nerve repairs and their results in children. Hand Clin 16:579–595Google Scholar
  2. 2.
    Waters PM, Bae DS (2012) Traumatic peripheral nerve injuries. In: Pediatric hand and upper limb surgery: a practical guide. Springhouse Publishing Co, U.S.Google Scholar
  3. 3.
    Sunderland S (1951) A classification of peripheral nerve injuries producing loss of function. Brain J Neurol 74:491–516CrossRefGoogle Scholar
  4. 4.
    Galanakos SP, Zoubos AB, Ignatiadis I, Papakostas I, Gerostathopoulos NE, Soucacos PN (2011) Repair of complete nerve lacerations at the forearm: an outcome study using Rosén-Lundborg protocol. Microsurgery 31:253–262. CrossRefGoogle Scholar
  5. 5.
    Chemnitz A, Björkman A, Dahlin LB, Rosén B (2013) Functional outcome thirty years after median and ulnar nerve repair in childhood and adolescence. J Bone Joint Surg Am 95:329–337. CrossRefGoogle Scholar
  6. 6.
    Tajima T, Imai H (1989) Results of median nerve repair in children. Microsurgery 10:145–146CrossRefGoogle Scholar
  7. 7.
    Barrios C, de Pablos J (1991) Surgical management of nerve injuries of the upper extremity in children: a 15-year survey. J Pediatr Orthop 11:641–645CrossRefGoogle Scholar
  8. 8.
    Lundborg G, Rosén B (2001) Sensory relearning after nerve repair. Lancet Lond Engl 358:809–810. CrossRefGoogle Scholar
  9. 9.
    Atherton DD, Taherzadeh O, Elliot D, Anand P (2008) Age-dependent development of chronic neuropathic pain, allodynia and sensory recovery after upper limb nerve injury in children. J Hand Surg Eur Vol 33:186–191. CrossRefGoogle Scholar
  10. 10.
    Stevenson JH, Zuker RM (1986) Upper limb motor and sensory recovery after multiple proximal nerve injury in children: a long term review in five patients. Br J Plast Surg 39:109–113CrossRefGoogle Scholar
  11. 11.
    Felice KJ, Royden Jones H (1996) Pediatric ulnar mononeuropathy: report of 21 electromyography-documented cases and review of the literature. J Child Neurol 11:116–120. CrossRefGoogle Scholar
  12. 12.
    Mc Donald CM (2015) Electrodiagnosis in pediatrics. In: Alexander MA, Matthews DJ (eds) Pediatric rehabilitation. principles and practice, Fifth edn. Demos Medical Publishing, New York, pp 113–152Google Scholar
  13. 13.
    Birch R (2011) Surgical disorders of peripheral nerves, 2nd edn. Springer-Verlag, LondonCrossRefGoogle Scholar
  14. 14.
    Woo A, Bakri K, Moran SL (2015) Management of ulnar nerve injuries. J Hand Surg 40:173–181. CrossRefGoogle Scholar
  15. 15.
    Ruijs ACJ, Jaquet J-B, Kalmijn S, Giele H, Hovius SER (2005) Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg 116:484–494 discussion 495–496CrossRefGoogle Scholar
  16. 16.
    Gaul JS (1982) Intrinsic motor recovery--a long-term study of ulnar nerve repair. J Hand Surg 7:502–508CrossRefGoogle Scholar
  17. 17.
    Lundborg G, Rosén B, Dahlin L et al (2004) Tubular repair of the median or ulnar nerve in the human forearm: a 5-year follow-up. J Hand Surg Edinb Scotl 29:100–107. CrossRefGoogle Scholar
  18. 18.
    Strickland JW, Idler RS, DelSignore JL (1991) Ulnar nerve repair. In: Gelberman RH (ed) Operative nerve repair and reconstruction. JB Lippincott, Philadelphia, pp 425–436Google Scholar
  19. 19.
    Bolitho DG, Boustred M, Hudson DA, Hodgetts K (1999) Primary epineural repair of the ulnar nerve in children. J Hand Surg 24:16–20. CrossRefGoogle Scholar
  20. 20.
    Sakellarides H (1962) A follow-up study of 172 peripheral nerve injuries in the upper extremity in civilians. J Bone Joint Surg Am 44-A:140–148CrossRefGoogle Scholar
  21. 21.
    Berger A, Mailänder P (1991) Advances in peripheral nerve repair in emergency surgery of the hand. World J Surg 15:493–500CrossRefGoogle Scholar
  22. 22.
    Escolar DM, Jones HR (1996) Pediatric radial mononeuropathies: a clinical and electromyographic study of sixteen children with review of the literature. Muscle Nerve 19:876–883.;876::AID-MUS10&gt;3.0.CO;2-H CrossRefGoogle Scholar
  23. 23.
    Pollock FH, Drake D, Bovill EG, Day L, Trafton PG (1981) Treatment of radial neuropathy associated with fractures of the humerus. J Bone Joint Surg Am 63:239–243CrossRefGoogle Scholar
  24. 24.
    Amillo S, Mora G (1999) Surgical management of neural injuries associated with elbow fractures in children. J Pediatr Orthop 19:573–577Google Scholar
  25. 25.
    Bertelli J, Soldado F, Ghizoni MF (2018) Outcomes of radial nerve grafting in children after distal humerus fracture. J Hand Surg.
  26. 26.
    Shergill G, Bonney G, Munshi P, Birch R (2001) The radial and posterior interosseous nerves. Results of 260 repairs. J Bone Joint Surg (Br) 83:646–649CrossRefGoogle Scholar
  27. 27.
    Jessing P (1975) Monteggia lesions and their complicating nerve damage. Acta Orthop Scand 46:601–609CrossRefGoogle Scholar
  28. 28.
    Brown JM, Tung THH, Mackinnon SE (2010) Median to radial nerve transfer to restore wrist and finger extension: technical nuances. Neurosurgery 66:75–83; discussion 83. Google Scholar
  29. 29.
    Ustün ME, Ogün TC, Büyükmumcu M (2001) Neurotization as an alternative for restoring finger and wrist extension. J Neurosurg 94:795–798. CrossRefGoogle Scholar
  30. 30.
    Jones HR (1986) Compressive neuropathy in childhood: a report of 14 cases. Muscle Nerve 9:720–723. CrossRefGoogle Scholar
  31. 31.
    Trojaborg W (1976) Motor and sensory conduction in the musculocutaneous nerve. J Neurol Neurosurg Psychiatry 39:890–899CrossRefGoogle Scholar
  32. 32.
    Osann E (1910) Beitrag zur Kenntnis der isolierten Lahmung des N. musculo-cutaneus. Dtsch Med Wochenschr 36:832–835CrossRefGoogle Scholar
  33. 33.
    Sunderland S (1968) Nerves and nerve injuriese. Livingstone, Edinburgh, pp 358–396Google Scholar
  34. 34.
    Babal JC, Mehlman CT, Klein G (2010) Nerve injuries associated with pediatric supracondylar humeral fractures: a meta-analysis. J Pediatr Orthop 30:253–263. CrossRefGoogle Scholar
  35. 35.
    Culp RW, Osterman AL, Davidson RS, Skirven T, Bora FW Jr (1990) Neural injuries associated with supracondylar fractures of the humerus in children. J Bone Joint Surg Am 72:1211–1215CrossRefGoogle Scholar
  36. 36.
    Novak CB, Anastakis DJ, Beaton DE, Katz J (2009) Patient-reported outcome after peripheral nerve injury. J Hand Surg 34:281–287. CrossRefGoogle Scholar
  37. 37.
    Nath RK, Karicherla P, Mahmooduddin F (2010) Shoulder function and anatomy in complete obstetric brachial plexus palsy: long-term improvement after triangle tilt surgery. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 26:1009–1019. CrossRefGoogle Scholar
  38. 38.
    Koenigsberger MR, Moessinger AC (1977) Iatrogenic carpal tunnel syndrome in the newborn infant. J Pediatr 91:443–445CrossRefGoogle Scholar
  39. 39.
    Spinner M, Schreiber SN (1969) Anterior interosseous-nerve paralysis as a complication of supracondylar fractures of the humerus in children. J Bone Joint Surg Am 51:1584–1590CrossRefGoogle Scholar
  40. 40.
    Pape KE, Armstrong DL, Fitzhardinge PM (1978) Peripheral median nerve damage secondary to brachial arterial blood gas sampling. - PubMed - NCBI. J Pediatr 93:852–856CrossRefGoogle Scholar
  41. 41.
    Drew SJ, Giddins GE, Birch R (1995) A slowly evolving brachial plexus injury following a proximal humeral fracture in a child. J Hand Surg Edinb Scotl 20:24–25CrossRefGoogle Scholar
  42. 42.
    Berry H, Bril V (1982) Axillary nerve palsy following blunt trauma to the shoulder region: a clinical and electrophysiological review. J Neurol Neurosurg Psychiatry 45:1027–1032CrossRefGoogle Scholar
  43. 43.
    Liveson JA (1984) Nerve lesions associated with shoulder dislocation; an electrodiagnostic study of 11 cases. J Neurol Neurosurg Psychiatry 47:742–744CrossRefGoogle Scholar
  44. 44.
    al-Ghazal SK, McKiernan M, Khan K, McCann J (1994) Results of clinical assessment after primary digital nerve repair. J Hand Surg Edinb Scotl 19:255–257CrossRefGoogle Scholar
  45. 45.
    Chaise F, Friol JP, Gaisne E (1993) Results of emergency repair of wounds of palmar collateral nerves of the fingers. Rev Chir Orthop Reparatrice Appar Mot 79:393–397Google Scholar
  46. 46.
    Efstathopoulos D, Gerostathopoulos N, Misitzis D, Bouchlis G, Anagnostou S, Daoutis NK (1995) Clinical assessment of primary digital nerve repair. Acta Orthop Scand Suppl 264:45–47CrossRefGoogle Scholar
  47. 47.
    Sriram K, Sakthivel A (1981) Sciatic nerve palsy in the new born. Ann Acad Med Singap 10:472–475Google Scholar
  48. 48.
    Ouvrier RA, Shield L (1999) Focal lesions of peripheral nerves. In: Ouvrier RA, Mcleod JG, Pollard JD (eds) Peripheral neuropathy in childhood. MacKeith Press, LondonGoogle Scholar
  49. 49.
    Levin KH, Wilbourn AJ, Jones HR (1991) Childhood peroneal neuropathy from bone tumors. Pediatr Neurol 7:308–309CrossRefGoogle Scholar
  50. 50.
    Jones HR, Felice KJ, Gross PT (1993) Pediatric peroneal mononeuropathy: a clinical and electromyographic study. Muscle Nerve 16:1167–1173. CrossRefGoogle Scholar
  51. 51.
    Wang J-C, Chan R, Yang T-F (2014) Delayed onset of peroneal neuropathy after minor ankle torsion in a 9-year-old boy. J Child Neurol 29:843–845. CrossRefGoogle Scholar
  52. 52.
    Hope EE, Bodensteiner JB, Thong N (1985) Neonatal lumbar plexus injury. Arch Neurol 42:94–95CrossRefGoogle Scholar
  53. 53.
    Egel RT, Cueva JP, Adair RL (1995) Posttraumatic childhood lumbosacral plexus neuropathy. Pediatr Neurol 12:62–64CrossRefGoogle Scholar
  54. 54.
    Chiou-Tan FY, Kemp K, Elfenbaum M et al (2001) Lumbosacral plexopathy in gunshot wounds and motor vehicle accidents: comparison of electrophysiologic findings. Am J Phys Med Rehabil 80:280–285 quiz 286–288CrossRefGoogle Scholar
  55. 55.
    Makarov MR, Samchukov ML, Birch JG, Cherkashin AM, Sparagana SP, Delgado MR (2012) Somatosensory evoked potential monitoring of peripheral nerves during external fixation for limb lengthening and correction of deformity in children. J Bone Joint Surg (Br) 94:1421–1426. CrossRefGoogle Scholar
  56. 56.
    Polo A, Zambito A, Aldegheri R, Tinazzi M, Rizzuto N (1999) Nerve conduction changes during lower limb lengthening. Somatosensory evoked potentials (SEPs) and F-wave results. Electromyogr Clin Neurophysiol 39:139–144Google Scholar
  57. 57.
    Polo A, Aldegheri R, Zambito A, Trivella G, Manganotti P, de Grandis D, Rizzuto N (1997) Lower-limb lengthening in short stature. An electrophysiological and clinical assessment of peripheral nerve function. J Bone Joint Surg (Br) 79:1014–1018CrossRefGoogle Scholar
  58. 58.
    Marquez S, Turley JJ, Peters WJ (1993) Neuropathy in burn patients. Brain J Neurol 116(Pt 2):471–483CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Universidad de LeónLeónSpain
  2. 2.Peripheral Nerve & Brachial Plexus Surgery Program, Department of NeurosurgeryUniversity of Buenos Aires School of MedicineBuenos AiresArgentina
  3. 3.Department of Plastic SurgeryComplejo Asistencial Universitario de LeónLeónSpain

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