Peripheral nerve palsies associated with closed fractures and dislocations

Area of Science:

• Orthopedic Surgery
• Neurology

Background:

• Peripheral nerve palsies frequently accompany upper and lower limb fractures and dislocations.
• Understanding prognostic indicators is crucial for effective patient management.

Purpose of the Study:

• To evaluate outcomes of peripheral nerve injuries associated with closed fractures and dislocations.
• To identify factors influencing spontaneous recovery and surgical indications.

Main Methods:

• Retrospective study of 203 patients (178 cases) with peripheral nerve palsies and limb fractures/dislocations.
• Exploration of 51 affected nerves, noting transection status.
• Analysis of surgical indications: high-energy injury, neuropathic pain, lack of progress, static Tinel's sign.

Main Results:

• Spontaneous recovery was limited (25/51) in non-operated, high-energy transfer injuries (circumflex, radial, common peroneal nerves).
• Good spontaneous recovery correlated with low-energy transfer injuries and an advancing Tinel's sign.
• Absence of Tinel's sign indicated conduction block, confirmed by neurophysiological studies.

Conclusions:

• Tinel's sign is a valuable indicator for assessing nerve injury severity and prognosis.
• Severe neuropathic pain suggests ongoing nerve damage, warranting surgical intervention.
• Early identification of nerve injury type and prognostic signs guides treatment decisions.