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Assessment of war and accidental nerve injuries in children
N Barisić1, D Perović, Z Mitrović
1Department of Pediatrics, Zagreb University Hospital, Croatia.
Insights
Pediatric peripheral nerve injuries from war often result in complete nerve damage and slower regeneration compared to accidental injuries. Accidental nerve injuries in children generally show better outcomes and faster recovery.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Regenerative Medicine
Background:
- Peripheral nerve injuries in children can arise from various causes, including trauma and conflict.
- Understanding the differences in injury patterns and recovery between war-related and accidental nerve injuries is crucial for effective treatment.
Purpose of the Study:
- To compare the clinical and electrophysiological outcomes of peripheral nerve injuries in children due to war versus accidental trauma.
- To evaluate the regeneration patterns and recovery timelines for these distinct injury types.
Main Methods:
- Clinical assessment and electromyoneurography (EMG) were performed on children aged 3-15 years.
- Patients were categorized into war-related (n=11) and accident-related (n=16) peripheral nerve injury groups.
- Nerve lesion severity, axonal damage, and reinnervation signs were monitored over 1-15 months.
Main Results:
- War-related injuries frequently involved complete axonal damage (7/11 children), while accidental injuries showed more partial lesions (11/16 children).
- Reinnervation signs appeared significantly later in war-injured children (mean 6.2 months) compared to accident-injured children (mean 3.4 months).
- War injuries were associated with complete denervation and delayed regeneration, whereas accidental injuries had a better overall course.
Conclusions:
- Pediatric peripheral nerve injuries sustained during wartime exhibit a more severe presentation with complete denervation and delayed nerve regeneration.
- Accident-related nerve injuries in children typically follow a more favorable clinical course with quicker reinnervation.
- These findings highlight the distinct prognoses and potential need for tailored management strategies based on injury etiology in pediatric nerve trauma.
Abstract:
Eleven children with war-related peripheral nerve injury and 16 children with accident-related nerve injury between the ages of 3 and 15 years were assessed clinically and electromyoneurographically for 1-15 months. Lesions of 32 peripheral nerves were registered in children with war injuries. Children with accidentally acquired injuries had lesions of 27 peripheral nerves. A complete loss of voluntary motor unit potentials and signs of total axonal damage were recorded in the upper arms of seven of 11 children with war injuries and in five of 16 children with accidental injuries. There was a diminished number of motor unit potentials and a reduction in compound muscle action potential amplitudes, indicating partial nerve lesions, in 11 of 16 children with accidental injuries (mostly after humeral fracture) and in three of 11 children with brachial plexus war injuries. Reinnervation signs first occurred after 5-9 months (mean = 6.2 months) in war-injured children receiving conservative treatment and after 2-7 months (mean = 3.4 months) in children with accidentally acquired injuries. War-related peripheral nerve injuries in children are more frequently associated with complete denervation followed by slower or delayed nerve regeneration. In children with accidentally acquired nerve injuries the course is significantly better.