Closed fractures complicated by peripheral nerve injury

Area of Science:

• Orthopedic Surgery
• Neurology
• Traumatology

Background:

• Closed fractures can involve peripheral nerve injuries, complicating treatment decisions due to limited clinical data.
• Most associated nerve injuries are local and without division, generally having a good prognosis.

Purpose of the Study:

• To outline optimal management strategies for peripheral nerve injuries in the context of closed fractures.
• To establish criteria for surgical intervention and guide intraoperative decision-making.

Main Methods:

• Review of clinical presentation and outcomes for peripheral nerve injuries secondary to closed fractures.
• Emphasis on conservative management (splinting, exercise) in the acute phase.
• Guidelines for electrodiagnostic testing and surgical exploration at six months if recovery is lacking.

Main Results:

• Immediate surgery is typically not warranted for closed fractures with nerve injury.
• Conservative management with splinting and exercise is the preferred initial approach.
• Surgical exploration at six months is indicated for non-recovering nerve injuries, with intraoperative nerve action potential measurements guiding repair techniques.

Conclusions:

• Peripheral nerve injuries from closed fractures usually benefit from initial non-operative management.
• Delayed surgical exploration with objective nerve testing is crucial for optimizing functional recovery in persistent cases.
• Intraoperative nerve action potential measurements are key to selecting the most effective surgical repair method.