Detection of Traumatic and Postoperative Nerve Lesions following Upper Extremity Fractures in a Pediatric Cohort Using MR Neurography.

Abstract

Fractures of the upper extremity are common traumatic injuries in children. Nerve lesions are a rare but typical complication of these fractures. Additional to physical, electrophysiological, and sonographic examinations, magnetic resonance neurography (MRN) can be used to assess the degree and exact localization of nerve damage. This retrospective study was conducted to evaluate the potential role of this examination technique for children and to test a proposed MRN classification of traumatic nerve injury according to Chhabra in a pediatric cohort. Pediatric patients undergoing MRN for traumatic nerve injury from January 2016 to December 2020 were retrospectively identified. A total of 12 consecutive patients with sufficient clinical data, an MRN, and if available follow-up examination were enrolled and analyzed. In 10 of 12 cases one or more nerve lesions could be identified by MRN using the classification proposed by Chhabra et al. MRN was used to assess nerve injuries, imaging results were compared with clinical course. Clinical follow-up examinations of 10 patients showed an overall good clinical recovery, even in one case with severe trauma and nerve surgery. MRN as a noninvasive procedure can help in the evaluation of nerve injury, especially for the identification of lower grade nerve damage and to objectify suspected nerve damage in case of uncertain clinical examination results; thus, can help in decision making whether surgical revision or conservative treatment is preferable.