Reasons and diagnostic errors in cases of the peripheral nerves of extremities injuring
DOI:
https://doi.org/10.14739/2310-1210.2014.4.27380Keywords:
Peripheral Nerves, Extremities, Injuries, Causes, Diagnostic ErrorsAbstract
Trauma of peripheral nerves of extremities takes leading place in disability cases (28-75%). The risk zones for injuring the nerves of upper extremity are shoulder and forearm, and of lower extremity are lower third of the thigh and the upper third of the tibia.
The aim of research: to analyze and identify the causes of diagnostic errors and complications in injuries of peripheral nerves of the extremities.
Material and methods:
Results of clinico-neurological and electrodiagnostical studying of 72 patients with injuries of upper and lower extremities are presented in the article. Patients were treated in 2010-2013 in traumatology department of Dnepropetrovsk state clinical hospital № 16.
The author distinguishes three forms of disturbance of the integrity of the neural trunk and five periods of their clinical course: neurotmesis - complete or partial break patterns of nerves, was diagnosed in 43 patients (59,7%); aksonotmesis - break part of axial cylinder, while maintaining the integrity of the epineurium - in 19 patients (26,4%) and neuropraxia - fine-grained lesions without violating the integrity of the axle of cylinders in 10 patients (13.9%). The types of peripheral nerve injuries of extremities were divided into 2 groups: primary and secondary (iatrogenic).
Results
The study showed that the most frequently pain from the injured nerves of the upper limb radiated at shoulder level, median and ulnar - at the level of the forearm. Diagnostic and therapeutic errors were detected at all stages of medical care, the author noted the insufficient assessment of neurological risk, in the pre-hospital and hospital stages, especially in cases of combined injuries. It is necessary to conduct more thorough clinical, radiological and electrophysiological assessment in the presence of small stab and cut wounds of the extremities.
Lack of the special tools and equipment, insufficient qualification of surgeons in matters of anatomical and topographical relationships between nerves, tendons and blood vessels in the soft tissues, as well as divergent views in the specialized literature, about terms of surgical and conservative treatment, about indications for them, leave the problem of peripheral nerve injuries is very topical issue of modern medicine.
Conclusions
- Trauma of peripheral nerves of extremities takes the leading place in permanent disability (28-75%) and occurs in 1,5 - 3,5 % of the total traumatism.
- Currently, the diagnosis and treatment of peripheral nerves of extremity has no generally accepted standardized system for assessing the level, degree and nature of the injury.
- In our opinion, the distribution of patients in our study into groups by the etiology and levels of damage the peripheral nerves, helped to clarify and to objectify the reasons for their traumatization, and find errors on the stages of diagnosis and treatment.
- Most commonly of the radial nerve trunks (45,8%), and on the forearm - the median and ulnar nerves (15,3%) are damaged.
References
Berstnev,V. P. (1986) Diahnostika i khirurgicheskoe lechenie povrezhdenij nervov konechnostei (Avtoref. dis… dokt. med. nauk) [Diagnosis and surgical treatment of nerve damage of limbs. Dr. med. sci. diss.] Leningrad. [in Russian].
Grigorovich, K. A. (1976). Znachenie vida travm nerva dlya iskhoda povrezhdeniya nerva [The value of the type of nerves injuries for outcome of it damages]. Vestnik khirurgii im. Grekova, 7, 128–132. [in Russian].
Grishyn, I. H., & Krupatkin, A. I. (1992). Diagnostika i taktika lecheniya povrezhdenij loktevogo sosudisto-nervnogo puchka [Diagnosis and treatment tactics of injuries of the ulnar neurovascular bundle]. Ortopediya, travmatologiya i protezirovanie, 2, 3–7. [in Ukrainian].
Kondrashov, A. N. (1974) Mestnaya gipotermiya v kompleksnom lechenii otkrytykh perelomov dlinnukh i trubchatykh kostej (Avtoref. dis…kand. med. nauk). [The local hypothermia in complex treatment of long bones fractures. (Extended abstract of candidate’s thesis). Dnepropetrovsk. [in Ukrainian].
Luzan, B. M., Kucheruk, O. Ye., Tatarchuk, M. M., Tsymbaliuk, Yu. V. (2013). Ushkodzhennia promenevogo nerva, poiednanni z perelomom plechovoi kistku [Damage to the radial nerve, combined with fractures of the humerus]. Travma, 14(5), 36–43. [in Ukrainian].
Matelenok, Ye. M. (1997). Rol’ loktevogo nerva v formirovanii kontraktur loktevogo sustava [The role of the ulnar nerve in the formation of contractures of the elbow joint]. Ortopediya, travmatologia i protezirovanie, 4, 26–29. [in Ukrainian].
Oniani, A. A. (1987) Obosnovanie srokov operativnukh vmeshatel’stv pri travmaticheskikh povrezhdeniakh perifericheskich nervov (Dis …kand. med. nauk). [Justification of the terms to operative interventions in traumatic injuries of peripheral nerves. Dr. med. sci. diss.]. Tbilisi. [in Georgia].
Popelyanskij, Ya. Yu. (1989). Bolezni perifericheskoj nervnoj sistemy [The diseases of peripheral nervous system]. Moskow: Medicina. [in Russian].
Samotkin, B. A., & Solomin, A. N. (1987). Oslozhneniya pri lechenii travm nervov konechnostej [The complications of the treatment the traumas of nerves at the extremities injuries]. Leningrad: Medicina. [in Russian].
Strafun, S. S., & Haiko, O. H. (2012). Kliniko-elektromiohrafichni stadii denervatsiino-reinnervatsiinoho protsessu u miazakh kintsivok pry ushkodzhenniakh periferichnykh nerviv [Clinical and electromyographical stages of denervation-reinnervation process in the muscles of the limbs with injuries of peripheral nerves]. Travma, 13(4), 121–127. [in Ukrainian].
Chelyshev, Yu. A., Rahinov, I. S., Kubitskii, A. A., Alekseeva, E. B., & Shahidylin, T. F. (2001) Prikladnye aspekty problemy reheneratsii perifericheskoho nerva [Applied aspects of the regeneration the peripheral nerves] Proceedings of the Scientific Conference «The materials of scientific conference “The morphological aspects of hystogenesis and tissue regeneration», (S. 11). Saint Petersburg. [in Russian].
De Franco, M. J., & Lawtow, J. N. (2006). Radial nerve injuries associated with humeral fractures. J. Hand. Surg. Am., 31, 655–663.
Stöhr, M. (1980) Jatrogene Nerven Lasionen. Stuttgart: New York.
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