Closed Injuries of a Radial Nerve: Surgical Treatment

Govenko F., Alekseev .

Medicomilitary Academy, Saint Petersburg, Russia

 

The research goal was to demonstrate peculiarities of closed injuries of a radial nerve. There were 78 cases, aged 6-63, with traumas of the radial nerve. They had closed (46) and open (32) injuries. All closed lesions were of a traction character (sustained in fractures of the humerus or the radius head).

Material and Methods. Open lesions were a result of incised wounds. Estimation of a muscular strength (the score of 1-5), electromyographic examination and intraoperative assessment of the nerve defect extent were carried out. All the cases underwent microsurgical operations. Their main condition was strain-free and precise end-to-end suturing of the nerve.

Results. Outcomes were studied in 3 years. Two peculiarities of closed trauma were found out. One of them consisted in the following: - The nerve defect, watched after resection of its ends, exceeded 5 cm, varying from 5 up to 18 cm (7.8 cm on the average). - It was 2.5-4.8, i.e. 3.9 cm on the average, in incised wounds (p<0.1). The second peculiarity (4 cases) was complete disruption of the nerve at its exit from the spiral canal or its injury with formation of gross neuroma at the entrance into it. Difference in a defect extent conditioned performing 3 versions of operations. If a defect was up to 6.5 cm, the nerve was sutured by epineurium; in 4 cases it was transposed under the biceps for ensuring a shorter way. Autoinserts were used in a defect of more 7-12 cm. The nerve was sutured via autoinserts, placed under the biceps in a defect of 13-18 cm. A muscular strength was characterized by a score of 4-5 in all the cases with wounds. The same index was typical of 4 and 34 cases, subjected to suturing with displacement and both versions of autoplasty respectively. Restoration of extension of a hand and fingers only (the scores of 4 and 2-3 respectively) was watched in 8 cases.
The aforesaid demonstrates, that traction trauma of the radial nerve demands applying different versions of interventions. Their outcomes are not always as favorable as those, watched in wounds. A two-level lesion of the radial nerve is a partial explanation of failures, observed in its suturing and described in literature.