Peripheral nerve palsies associated with closed fractures and dislocations

We have studied 178 consecutive cases of 203 patients admitted to this unit between 1999 and 2003 with diagnosis of peripheral nerve palsies associated with closed fractures and dislocations in the upper and lower limbs. Fifty-one nerves were explored, 25 of which were found partly or completely transected. Indications for surgery were high-energy transfer injury, severe neuropathic pain, failure to progress and a static Tinel's sign. Spontaneous recovery was good in only 25 of the 51 non-operated cases of high-energy transfer injury to the circumflex, radial and common peroneal nerves. Good spontaneous recovery is closely related to low-energy transfer injury, and is associated with an advancing Tinel's sign. Absence of the Tinel's sign indicates conduction block; neurophysiological investigation confirms it. We stress the particular value of the Tinel's sign, and note that severe neuropathic pain indicates continuing damage to the nerve and gives a strong reason for operation.