Frequency Of Nerve Injury Research Articles

Acute pain syndromes in injuries to the nerves and plexuses of the limbs

Injuries of peripheral nerves and plexuses cause serious disorders in the affected limbs. Unfortunately, the frequency of nerve injuries and limb plexuses is steadily increasing in our country, due to hostilities, which emphasizes the extreme relevance of this pathology. The aim of the review is to consider the current data on pathophysiological mechanisms, clinical manifestations, and treatment of acute pain syndromes in patients with injuries of peripheral nerves and limb plexuses. Materials and methods. Scientific databases PubMed, Google Scholar, Scopus, Cochrane Library, as well as the materials of the International Association for the study of pain were used to search for sources of research information. The main studies were found in Pubmed, Google Scholar and materials of the International Association for the study of pain and made up 191 sources of information, 150 of which were excluded from the review due to insufficient data on pathophysiological mechanisms, clinical manifestations, and treatment of pain syndromes in patients with damage to the nerves and plexuses of the limbs, thus 41 sources of information formed the basis of the review. Results: Brachial plexus and peripheral nerve injuries can be associated with any combination of nociceptive, neuropathic, phantom limb pain, and even complex regional pain syndromes. Acute neuropathic pain is an under-recognized condition, often difficult to treat and can progress to persistent pain and disability. Neuropathic pain develops because the main damage affects the somatosensory system. It is caused by peripheral nerve damage and associated changes in the central nervous system. The first line of pharmacological treatment for neuropathic pain according to current guidelines is anticonvulsant drugs that affect neuronal calcium channels, as well as tri- and tetracyclic antidepressants and selective serotonin/norepinephrine reuptake inhibitors. Conclusions: At the current stage, progress has been made in understanding the mechanisms of development of the pathological condition and in the development of therapeutic approaches, however, the chronicity of pain syndrome in patients with damage to the nerves and plexuses of the limbs is still high, which requires further research to develop complex pathogenetic therapy and better understanding of the mechanisms pain in this category of patients

Nerve injuries due to fractures in childhood : Primarily and secondarily on the upper extremity

The approach for nerve injuries in children in the context of fractures of the upper extremities is inconsistent in the literature. The underlying mostly retrospective studies do not usually consider the potential diagnostics. The frequency of nerve injuries with aclear need for reconstructive surgery is sometimes estimated so differently that precedent-setting errors in these studies must be assumed; however, as 10-20% of pediatric fractures near the elbow show primary or secondary nerve lesions, timely and appropriate further treatment is necessary. An overview concerning diagnostic tools with an explanation of potential results and an algorithm with atimeline for diagnostic and therapeutic management are presented. Good results after nerve lesions can only be achieved when timely diagnostics without delay and correct detection of axonal lesions which benefit from surgical treatment are carried out.

Etiology and pattern of maxillofacial trauma.

Maxillofacial trauma can be limited to superficial lacerations, abrasions, and facial bone fractures. The objective of this study was to determine the etiology, pattern, and predictors of soft tissue and bony injuries. This study was conducted in the department of maxillofacial surgery Lady Reading hospital Pakistan from Jan 2019 to June 2021. The nonprobability consecutive sampling technique was used for the selection of patients. All patients were assessed clinically and radiologically. The neurosensory examination was done for any altered sensation, anesthesia, or paresthesia. Motor nerve function was also assessed clinically. Data were analyzed using SPSS version 26. The etiology and pattern of maxillofacial trauma were stratified among age and genders using the chi-square test to see effect modifiers. Tests for regression analysis were also applied. P≤0.05 was considered significant. A total of 253 patients meeting inclusion criteria were included in this study. The majority of these patients were males, 223 (88.1%), while only 30 (11.9%) were females. The mean age for the group was 25.4 ± 12.6 years. RTAs were the most common causes of trauma (63.6%) followed by assault (15.0%), falls (11.5%), FAIs (5.9%), and sports (0.4%). The most vulnerable skeletal part was the mandible (22.9%) followed by Zygoma (7.1%), significantly predicted by RTAs. Soft tissue laceration analysis showed a high frequency of multiple lacerations (38%) significantly predicted by FAIs. The frequency of trigeminal nerve injury was 5.5% (14 patients) and that of the facial nerve was 1.6% (4 patients). The strongest association of nerve injury was with firearm injury (47%), followed by road traffic accidents and sports injuries. Road traffic accident was the most common etiological factor and mandible fracture was commonly predicted by RTA. Trigeminal nerve injuries were common, frequency of nerve injuries was highly associated with mandible fracture and was predicted by FAI.

Multimodality Intraoperative Neurophysiological Monitoring (IONM) During Shoulder Surgeries

ABSTRACT Introduction: The purpose of this study is to identify the advancing role of Intraoperative Neurophysiological Monitoring (IONM) in detecting and preventing nerve injuries during shoulder surgery procedures. Methods: We performed a retrospective analysis of IONM data from ten shoulder procedures. The patients consisted of nine females and one male with ages ranging from 67 to 81 years (median: 74 years). IONM modalities utilized were bilateral Somatosensory Evoked Potentials (SSEP), Transcranial Motor Evoked Potentials (TCeMEP), ipsilateral Electromyogram (EMG) from upper extremity muscles and Train of four (TOF) recordings. Results: A decrease in signals was noted in three patients (30%). Only upper SSEP amplitude decreased in one patient; both upper extremity SSEP and TCeMEP decreased in two patients. Only one patient had poor baseline radial nerve SSEP that improved during the surgery. We performed spontaneous EMG (s-EMG) in all ten patients and successfully recorded triggered (t-EMG) in seven patients (71.4%). In one patient, SSEP and TCeMEP did not improve, and the patient woke up with deficits. Conclusions: In this small series, we were able to identify real-time impending nerve injury. The use of IONM alerted and may have prevented intraoperative nerve injury in 30% of the patients in this series. In one patient, SSEP and TCeMEP did not recover even after the intervention due to severe blood loss. The patient woke up with sensory and motor deficits. The utilization of multimodality IONM can be helpful due to signal changes, therefore minimizing the frequency of nerve injury and deficits.

PATTERN OF MAXILLOFACIAL TRAUMA

Objectives: To determine the pattern of maxillofacial injuries in the localpopulation. Study Design: Retrospective clinical and epidemiologic study. Period: January2009 to December 2013. Setting: Tertiary care hospital. Methods: 3360 patients reported formaxillofacial injuries. A number of parameters, including age, gender, facial bone fractures,laceration on face, injury of trigeminal and facial nerve branches, sensory and motor deficit inrelation to soft tissue trauma and bone fracture, were evaluated. Results: Males were dominantand male to female ratio was 6.3:1. Patients of 3rd decade were more and constitute 63.2%.Road traffic accident was the common etiological factor (78%). Mandible fracture was dominantand it was present in 1591 patients (47.7%). Soft tissue laceration frequency was high in cheekregion and was 13.7%. Sensory deficit (Trigeminal nerve injury) was present in 1167 patients(34.7%). Motor deficit (Facial nerve injury) was present in 249 patients (6.83%). Nerve injuriesin relation to mandible fracture were common. Conclusion: Road traffic accident was the mostcommon etiological factor and mandible fracture was common. Trigeminal nerve injuries werecommon and frequency of nerve injuries was high in relation to mandible fracture.

Vascular and Nerve Injury After Knee Dislocation: A Systematic Review

Vascular injury is a devastating complication of acute knee dislocation. However, there are wide discrepancies in the reported frequency of vascular injury after knee dislocations, as well as important differences among approaches for diagnosis of this potentially limb-threatening problem. We determined (1) the frequency of vascular and neurologic injury after knee dislocation and whether it varied by the type of knee dislocation, (2) the frequency with which surgical intervention was performed for vascular injury in this setting, and (3) the frequency with which each imaging modality was used to detect vascular injury. We searched the MEDLINE(®) literature database for studies in English that examined the clinical sequelae and diagnostic evaluation after knee dislocation. Vascular and nerve injury incidence after knee dislocation, surgical repair rate within vascular injury, and amputation rate after vascular injury were used to perform a meta-analysis. Other measures such as diagnostic modality used and the vessel injured after knee dislocation were also evaluated. We identified 862 patients with knee dislocations, of whom 171 sustained vascular injury, yielding a weighted frequency of 18%. The frequency of nerve injuries after knee dislocation was 25% (75 of 272). We found that 80% (134 of 160) of vascular injuries underwent repair, and 12% (22 of 134) of vascular injuries resulted in amputation. The Schenck and Kennedy knee dislocation classifications with the highest vascular injury prevalence were observed in knees that involved the ACL, PCL, and medial collateral liagment (KDIIIL) (32%) and posterior dislocation (25%), respectively. Selective angiography was the most frequently used diagnostic modality (61%, 14 of 23), followed by nonselective angiography and duplex ultrasonography (22%, five of 23), ankle-brachial index (17%, four of 23), and MR angiography (9%, two of 23). This review enhances our understanding of the frequency of vascular injury and repair, amputation, and nerve injuries after knee dislocation. It also illustrates the lack of consensus among practitioners regarding the diagnostic and treatment algorithm for vascular injury. After pooling existing data on this topic, no outcomes-driven conclusions could be drawn regarding the ideal diagnostic modality or indications for surgical repair. In light of these findings and the morbidity associated with a missed diagnosis, clinicians should err on the side of caution in ruling out arterial injury.