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Iatrogenic "overshoot" nerve injuries: imaging features
Yoshimi Endo1, Ogonna K Nwawka2, Darryl B Sneag2
1Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA. endoy@hss.edu.
Skeletal Radiology
|January 2, 2024
Summary
Iatrogenic nerve injuries from surgical instruments can be identified by secondary signs on imaging. These include cortical defects, scar tissue, screw tips, and bone tracts pointing to the injured nerve.
Area of Science:
- Radiology
- Orthopedic Surgery
- Neurology
Background:
- Iatrogenic nerve injuries can occur during orthopedic procedures.
- Overshoot nerve injuries happen when surgical instruments damage nerves after penetrating bone.
Purpose of the Study:
- To describe the ultrasound and MRI features of iatrogenic "overshoot" nerve injuries.
- To identify secondary imaging signs indicative of this specific nerve injury mechanism.
Main Methods:
- Retrospective review of radiology database (2016-2022) at an orthopedic hospital.
- Inclusion criteria: instrumentation through bone, acute neuropathy, electrodiagnostic confirmation, and imaging consistent with overshoot injury.
- Evaluation of ultrasound and MRI studies for primary and secondary signs.
Main Results:
- Six patients with overshoot nerve injuries were identified.
- Injuries involved radial, tibial, superficial peroneal, and posterior interosseous nerves during fracture fixation and tendon repair.
- Secondary signs observed: cortical defects (n=2), scar (n=2), screw tip proximity (n=1), and bone tracts on MRI (n=2).
Conclusions:
- Secondary imaging signs are crucial for diagnosing overshoot nerve injuries.
- These signs include cortical defects, scar extension to the nerve, screw tip orientation, and bone tracts on MRI.
- Recognizing these features aids in accurate diagnosis and management of iatrogenic nerve damage.
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