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Primary epineural repair of the ulnar nerve in children
D G Bolitho1, M Boustred, D A Hudson
1Hand Unit, Red Cross Children's Hospital, University of Cape Town, South Africa.
Insights
Primary epineural repair effectively restores motor and sensory function in children under 13 with acute transectional ulnar nerve injuries. This surgical approach yields satisfactory outcomes, even with associated injuries or proximal nerve damage.
Area of Science:
- Pediatric Surgery
- Neurology
- Orthopedics
Background:
- Transectional nerve injuries are rare in pediatric populations.
- Ulnar nerve injuries can significantly impact hand function.
Purpose of the Study:
- To evaluate the outcomes of primary epineural repair in children with acute transectional ulnar nerve injuries.
- To assess both motor and sensory recovery following surgical intervention.
Main Methods:
- Retrospective case series of 19 children (aged <= 13 years) with acute transectional ulnar nerve injuries.
- Primary epineural repair was performed on all participants.
- Outcomes were assessed using the Medical Research Council scale for motor function and static 2-point discrimination for sensory function.
Main Results:
- Mean recovery grade for the first dorsal interosseous muscle was 4.0 (MRC scale).
- Mean recovery grade for the abductor digiti minimi was 3.9 (MRC scale).
- Mean static 2-point discrimination was 6 mm, indicating good sensory recovery.
Conclusions:
- Primary epineural repair is a successful treatment for acute transectional ulnar nerve injuries in children younger than 13.
- Satisfactory motor and sensory recovery is achievable, even with proximal injuries or associated structural damage.
Abstract:
Transectional nerve injuries are uncommon in children. We report the outcome of 19 children aged < or = 13 years with acute transectional injuries to the ulnar nerves who were treated by primary epineural repair. There were 13 boys and 6 girls with a mean age at the time of injury of 6.7 years (range, 2-12 years). The site of injury was the palm in 4 children, wrist in 10, forearm in 4, and above the elbow in 1. Associated injuries to other structures occurred in 13 children. The mean recovery (Medical Research Council scale) of the first dorsal interosseous muscle was grade 4.0 (range, grade 3-5) and the mean outcome for the abductor digiti minimi was grade 3.9 (range, grade 2-5). The mean static 2-point discrimination was 6 mm (range, 2-20 mm). The mean follow-up period was 50 months (range, 12-103 months). Although proximal injuries (at or above the elbow) had a poorer outcome, satisfactory function of the intrinsic hand muscles still occurred; this finding contrasts to results reported in adults. Similarly, associated injuries to adjacent structures had no impact on ulnar nerve recovery. Primary epineural repair of the acutely transected ulnar nerve leads to a satisfactory recovery in both motor and sensory function in children younger than 13 years.