8 - Nerve Injury and Repair in Children

Abstract

Nerve injuries in children are relatively uncommon; however, children tend to put their hands in all sorts of unexpected places with sharp objects. Garbage disposals, conveyer belts, and dishwashers are uninteresting to adults but are a fascinating source of curiosity for children. Reaching into a nest of sharp surfaces can lead to varying degrees of damage to the pediatric hand, including nerve injury. In emerging countries, childhood labor is common and occupational safety is lacking, which leads to dangerous conditions. In addition, the advent of high-velocity sporting events like the X Games has resulted in an increasing incidence of severe, high-energy fractures in children, with periosteal disruption and marked fracture displacement. The surrounding nerve(s) are in jeopardy from sharp, bony fragments unchecked by the normal encompassing periosteum. Even if the nerves are not lacerated from the fracture fragments, traction on the nerves and swelling may result in nerve injury and compartment syndrome. Lastly, although iatrogenic nerve injuries are uncommon, surgeons unfamiliar with the idiosyncrasies of the pediatric musculoskeletal system can make the operating room a less safe place for children. Regardless of the cause, iatrogenic nerve injuries are distressing to the physician, child, and family. This chapter will discuss the prevention, diagnosis, and treatment of upper extremity nerve injuries in children.