Median and ulnar nerve injuries; what causes different repair outcomes?

Nouraei, Mohammad Hadi; Hosseini, Alireza; Salek, Shadi; Nouraei, Farhad; Bina, Roya

Median and ulnar nerve injuries; what causes different repair outcomes?

Authors

¹ Department of Orthopedic Surgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Pediatrics, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

³ Students' Research Committee, International Islamic Azad University of Khorasgan, Isfahan, Iran

⁴ Department of Internal Medicine, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Peripheral nerve injuries have significant effects on patients' life quality. To make patients' therapeutic expectations more realistic, prediction of repair outcome has significant importance.
Materials and Methods: Totally, 74 patients with 94 nerve injuries (44 median and 50 ulnar nerves) were evaluated and followed up for 5 years between 2008 and 2013 in two main university hospitals of Isfahan. Patients' age was 6–64 years. 24 nerves were excluded from the study and among the remaining; 53 nerves were repaired primarily and 17 nerves secondarily. 42 nerves were injured at a low-level, 17 nerves at intermediate and 11 at a high one. Medical Research Council Scale used for sensory and motor assessment. S₃₊and S₄scores for sensory recovery and M₄and M₅scores for motor recovery were considered as favorable results. The follow-up time was between 8 and 24 months.
Results: There was no significant difference between favorable sensory outcomes of median and ulnar nerves. The difference between favorable motor outcomes of the median nerve was higher than ulnar nerve (P = 0.03, odds ratio = 2.9). More favorable results were seen in high-level injuries repair than low ones (P = 0.035), and also cases followed more than 18 months compared to less than 12 months (P = 0.041), respectively. The favorable outcomes for patients younger than 16 were more than 40 and older, however, their difference was not significant (P = 0.059).The difference between primary and secondary repair favorable outcomes was not significant (P = 0.37).
Conclusion: In patients older than 40 or injured at a high-level, there is a high possibility of repetitive operations and reconstructive measures. The necessity for long-term follow-up and careful attentions during a postoperative period should be pointed to all patients.

Keywords

References

1.	Lad SP, Nathan JK, Schubert RD, Boakye M. Trends in median, ulnar, radial, and brachioplexus nerve injuries in the United States. Neurosurgery 2010;66:953-60.
2.	Krishnan KG, Martin KD, Schackert G. Traumatic lesions of the brachial plexus: An analysis of outcomes in primary brachial plexus reconstruction and secondary functional arm reanimation. Neurosurgery 2008;62:873-85; discussion 885.
3.	DeFranco MJ, Lawton JN. Radial nerve injuries associated with humeral fractures. J Hand Surg Am 2006;31:655-63.
4.	Chemnitz A, Björkman A, Dahlin LB, Rosén B. Functional outcome thirty years after median and ulnar nerve repair in childhood and adolescence. J Bone Joint Surg Am 2013 20;95:329-37.
5.	Brushart T. Nerve repair and grafting. In: Green D, Hotchkiss R, Pederson W, editors. Green's Operative Hand Surgery. New York: Churchill Livingstone Company; 2010. p. 1381-403.
6.	Jobe M, Martinez S. Peripheral nerve injuries. In: Canale ST, editor. Campbell's Operative Orthopaedics. Missouri: Mosby Company; 2008. p. 3221-83.
7.	Wood MD, Kemp SW, Gregory CW. Outcome measures of peripheral nerve regeneration. Ann Anat 2011;193:321-33.
8.	Fornander L, Nyman T, HanssonT, Ragnehed M, Brismar T. Age-and time-dependent effects on functional outcome and cortical activation pattern in patients with median nerve injury: A functional magnetic resonance imaging study clinical article. J Neurosurg 2010;113:122-8.
9.	Miller LK, Chester R, Jerosch-Herold C. Effects of sensory reeducation programs on functional hand sensibility after median and ulnar repair: A systematic review. J Hand Ther 2012;25:297-306; quiz 307.
10.	Novak CB, Anastakis DJ, Beaton DE, Katz J. Patient-reported outcome after peripheral nerve injury. J Hand Surg Am 2009;34:281-7.
11.	Ruijs AC, Jaquet JB, Kalmijn S, Giele H, Hovius SE. Median and ulnar nerve injuries: A meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg 2005;116:484-94; discussion 495.
12.	Bukhari AJ, Saleem M, Bhutta AR, Khan AZ, Abid KJ. Spaghetti wrist: Management and outcome. J Coll Physicians Surg Pak 2004;14:608-11.
13.	Ertem K, Denizhan Y, Yologlu S, Bora A. The effect of injury level, associated injuries, the type of nerve repair, and age on the prognosis of patients with median and ulnar nerve injuries. Acta Orthop Traumatol Turc 2005;39:322-7.
14.	Post R, de Boer KS, Malessy MJ. Outcome following nerve repair of high isolated clean sharp injuries of the ulnar nerve. PLoS One 2012;7:e47928.
15.	Roganovic Z. Missile-caused ulnar nerve injuries: Outcomes of 128 repairs. Neurosurgery 2004;55:1120-9.

Advanced Biomedical Research