The concept of limb function recovery in traumatic injury of peripheral nerves

Abstract

Purpose. To develop key principles in the treatment of traumatic injury of peripheral nerves basing on analysis of injury of peripheral nerves severity, and structural and functional condition of muscles. Materials and methods. We analyzed the results of treatment of 726 patients with injury of peripheral nerves of the extremities. Injury of the upper extremity had 345 (47.5%) patients, with lower limb trauma 381 (52.5%) patients. Electromyography study was performed to 460 patients on “Neuroscreen” (Toenis, Germany) and “Viking Quest” (Nicollet, USA). Ultrasound of muscles was performed to 185 patients on HDI 3500 device and HD 11 XE (Philips) with a multifrequency linear transducer (5–12 MHz). Results. In 70.2 % of cases, nerve injury has polystructural injury of two or more anatomical and functional structures. Based on the analysis of clinical examination, ultrasound and EMG data characteristics we proposed the concept of the treatment of peripheral nerve injuries in limbs trauma and highlighted its main points: the definition of the level and severity of the nerve damage, forecast its recovery and muscle reinnervation; assessment of the nature and degree of severity of the key muscle (denervation or a combination of several pathological processes), assessment of damage to other structures of the injured limb segment allowing for the polystructural injury treatment algorithm.