Abstract
Iatrogenic peripheral nerve injuries in orthopedic surgery can result from direct nerve injury during surgery or indirect injury through compression, stretch, or thermal damage. The mechanism, type, and time to diagnosis of a nerve injury shape prognosis and treatment options. Orthopedic surgeons must understand the evaluation and treatment options for iatrogenic peripheral nerve injuries and promptly refer patients for evaluation by a peripheral nerve expert to maximize the opportunity for restoration of function. While sharply transected nerves can be repaired immediately, many injuries require advanced techniques including neurolysis, nerve transfer, nerve grafting, and distal decompression.
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References
Antoniadis G, Kretschmer T, Pedro MT, Konig RW, Heinen CP, Richter HP. Iatrogenic nerve injuries: prevalence, diagnosis and treatment. Dtsch Arztebl Int. 2014;111(16):273–9.
Kretschmer T, Antoniadis G, Braun V, Rath SA, Richter HP. Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma. J Neurosurg. 2001;94(6):905–12.
Pulos N, Shin EH, Spinner RJ, Shin AY. Management of Iatrogenic nerve ijuries. J Am Acad Orthop Surg. 2019;27(18):e838–e48.
Rasulic L, Savic A, Vitosevic F, et al. Iatrogenic peripheral nerve injuries-surgical treatment and outcome: 10 years' experience. World Neurosurg. 2017;103:841–51 e6.
Winfree CJ, Kline DG. Intraoperative positioning nerve injuries. Surg Neurol. 2005;63(1):5–18; discussion.
James MA. Use of the Medical Research Council muscle strength grading system in the upper extremity. J Hand Surg Am. 2007;32(2):154–6.
Cuthbert SC, Goodheart GJ Jr. On the reliability and validity of manual muscle testing: a literature review. Chiropr Osteopat. 2007;15:4.
Shahgholi L, Bengtson KA, Bishop AT, et al. A comparison of manual and quantitative elbow strength testing. Am J Phys Med Rehabil. 2012;91(10):856–62.
Bertelli JA, Ghizoni MF. Abduction in internal rotation: a test for the diagnosis of axillary nerve palsy. J Hand Surg Am. 2011;36(12):2017–23.
Schoeller T, Otto A, Wechselberger G, Pommer B, Papp C. Distal nerve entrapment following nerve repair. Br J Plast Surg. 1998;51(3):227–9; discussion 30.
Kane PM, Daniels AH, Akelman E. Double crush syndrome. J Am Acad Orthop Surg. 2015;23(9):558–62.
Shin AY, Spinner RJ, Steinmann SP, Bishop AT. Adult traumatic brachial plexus injuries. J Am Acad Orthop Surg. 2005;13(6):382–96.
Ma J, Novikov LN, Kellerth JO, Wiberg M. Early nerve repair after injury to the postganglionic plexus: an experimental study of sensory and motor neuronal survival in adult rats. Scand J Plast Reconstr Surg Hand Surg. 2003;37(1):1–9.
Kim DH, Murovic JA, Tiel R, Kline DG. Management and outcomes in 353 surgically treated sciatic nerve lesions. J Neurosurg. 2004;101(1):8–17.
Martin E, Senders JT, DiRisio AC, Smith TR, Broekman MLD. Timing of surgery in traumatic brachial plexus injury: a systematic review. J Neurosurg. 2018;1:1–13.
Fu SY, Gordon T. Contributing factors to poor functional recovery after delayed nerve repair: prolonged denervation. J Neurosci. 1995;15(5 Pt 2):3886–95.
Gordon T, Tyreman N, Raji MA. The basis for diminished functional recovery after delayed peripheral nerve repair. J Neurosci. 2011;31(14):5325–34.
Campbell WW. Evaluation and management of peripheral nerve injury. Clin Neurophysiol. 2008;119(9):1951–65.
Mamede S, Schmidt HG. The twin traps of overtreatment and therapeutic nihilism in clinical practice. Med Educ. 2014;48(1):34–43.
Helo S, Moulton CE. Complications: acknowledging, managing, and coping with human error. Transl Androl Urol. 2017;6(4):773–82.
Chamberlain CJ, Koniaris LG, Wu AW, Pawlik TM. Disclosure of "nonharmful" medical errors and other events: duty to disclose. Arch Surg. 2012;147(3):282–6.
Schwappach DL, Koeck CM. What makes an error unacceptable? A factorial survey on the disclosure of medical errors. Int J Qual Health Care. 2004;16(4):317–26.
Grinsell D, Keating CP. Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. Biomed Res Int. 2014;2014:698256.
Finucane BT. Complications of regional anesthesia. Springer; 2007.
Katirji B. Electromyography in clinical practice E-book: a case study approach. Elsevier Health Sciences; 2007.
Robinson LR. Traumatic injury to peripheral nerves. Muscle Nerve. 2000;23(6):863–73.
Ashwell ZR, Froelich JM, Strickland CD. Unique utility of sonography for detection of an iatrogenic radial nerve injury. J Ultrasound Med. 2016;35(5):1101–3.
Bodner G, Harpf C, Gardetto A, et al. Ultrasonography of the accessory nerve: normal and pathologic findings in cadavers and patients with iatrogenic accessory nerve palsy. J Ultrasound Med. 2002;21(10):1159–63.
Cesmebasi A, Smith J, Spinner RJ. Role of sonography in surgical decision making for iatrogenic spinal accessory nerve injuries: a paradigm shift. J Ultrasound Med. 2015;34(12):2305–12.
Kim DH, Han K, Tiel RL, Murovic JA, Kline DG. Surgical outcomes of 654 ulnar nerve lesions. J Neurosurg. 2003;98(5):993–1004.
Millesi H, Meissl G, Berger A. The interfascicular nerve-grafting of the median and ulnar nerves. J Bone Joint Surg Am. 1972;54(4):727–50.
Bassilios Habre S, Bond G, Jing XL, Kostopoulos E, Wallace RD, Konofaos P. The surgical management of nerve gaps: present and future. Ann Plast Surg. 2018;80(3):252–61.
Panagopoulos GN, Megaloikonomos PD, Mavrogenis AF. The present and future for peripheral nerve regeneration. Orthopedics. 2017;40(1):e141–e56.
Wilson TJ, Kleiber GM, Nunley RM, Mackinnon SE, Spinner RJ. Distal peroneal nerve decompression after sciatic nerve injury secondary to total hip arthroplasty. J Neurosurg. 2018;130(1):179–83.
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Shlykov, M.A., Velicki, K.M., Dy, C.J. (2022). Evaluation of the Patient with Postoperative Peripheral Nerve Issues. In: Dy, C.J., Brogan, D.M., Wagner, E.R. (eds) Peripheral Nerve Issues after Orthopedic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-84428-8_2
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DOI: https://doi.org/10.1007/978-3-030-84428-8_2
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