Iatrogenic nerve injuries in orthopaedics

Abstract

Peripheral nerves are at risk of injury during both orthopaedic trauma and elective surgery. The aims of this review are to raise awareness of iatrogenic nerve injuries and recommend strategies clinicians can employ to aid diagnosis, management and improve recovery for patients. A thorough understanding of anatomy and appreciation of pathoanatomy in fracture surgery can help reduce this risk. When injuries occur, a systematic clinical assessment can usually locate the site of injury, and with a repeated examination, the physiological grade can be determined. The neurapraxic injury may deteriorate if the conditions around the nerve are unfavourable. Caution should be exerted when making a diagnosis of conduction block because close, regular clinical monitoring is necessary to detect any deterioration early. Surgery may be required in such injuries if there is a failure to progress or deterioration occurs. Higher grade injuries may require surgical exploration and reconstruction. These procedures are most appropriately performed by specialist surgeons working in regional nerve injury units. Early diagnosis and management of an iatrogenic injury reduces the emotional impact, may prevent central pain sensitisation and ensures the optimum chance of useful functional recovery.