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Traumatic Upper Extremity Nerve Lesions in Children: High-Resolution Nerve Ultrasound Can Improve Surgical Outcome
Natalie Winter1,2, Alexander Grimm1,2, Johannes Heinzel3
1Department of Epileptology, Center for Neurology, Eberhard Karls University, Tuebingen, Germany.
Insights
High-resolution ultrasound (HRUS) aids in diagnosing pediatric upper extremity nerve injuries. HRUS-guided treatment and younger age predict better outcomes, supporting its use in management.
Area of Science:
- Pediatric neurosurgery
- Musculoskeletal imaging
- Traumatology
Background:
- Peripheral nerve injuries (PNIs) are common in pediatric extremity trauma, leading to significant morbidity.
- Diagnosing PNIs in children is challenging due to compliance issues with traditional methods.
- High-resolution ultrasound (HRUS) offers a promising, noninvasive diagnostic solution, but lacks clear management guidelines.
Purpose of the Study:
- To evaluate clinical outcomes of conservative versus surgical management for pediatric upper extremity PNIs.
- To assess the role of HRUS findings in predicting treatment success.
- To identify predictors of favorable outcomes in pediatric PNI patients.
Main Methods:
- Retrospective analysis of a pediatric neurosurgery database (2008-2022) for traumatic upper extremity PNIs in patients under 18.
- Inclusion of systematic HRUS examinations from 2016 onwards.
- Assessment of clinical, intraoperative, sonographic, and electrophysiological data.
Main Results:
- 73 nerve injuries in 67 pediatric patients were analyzed; ulnar, radial, and median nerves were most affected.
- 49.3% underwent surgery, while 50.7% received conservative management; initial deficits were more severe in surgical candidates.
- No significant difference in final nerve function between surgical and conservative groups.
- Age (<9 years), HRUS findings, and the specific injured nerve were independent predictors of outcome.
Conclusions:
- Pediatric patients with peripheral nerve injuries can achieve good functional recovery.
- High-resolution ultrasound-guided treatment and younger age (<9 years) are key predictors of favorable outcomes.
- HRUS is a valuable, noninvasive tool for guiding the management of pediatric nerve injuries.
Background:
Peripheral nerve injuries may accompany traumatic extremity injuries and are associated with significant morbidity. Diagnostic options are limited in young children since compliance might be restricted. High-resolution ultrasound (HRUS) is a promising technique to close the diagnostic gap, but clear recommendations are lacking. This study evaluates clinical outcomes after conservative versus surgical management, considering HRUS findings in pediatric patients with upper extremity peripheral nerve injuries.
Methods:
We retrospectively analyzed our pediatric neurosurgery database from August 2008 to December 2022 including patients < 18 years with traumatic upper extremity nerve injury and excluding obstetrical brachial plexus injury. Systematic HRUS examinations were implemented from 2016 onwards. Clinical, intraoperative, sonographic and electrophysiological findings were assessed.
Results:
A total of 73 nerve injuries in 67 patients (median age = 7.0 years) were analyzed. The most frequently affected nerves were the ulnar (49.3%), radial (21.9%), and median nerve (19.2%). At initial presentation, 47.9% underwent electrophysiology and 67.1% received HRUS. Surgery was performed in 49.3% at a median of 4 months posttrauma, whereas 50.7% were managed conservatively. Patients undergoing surgery initially had more severe sensory and motor deficits (χ 2 = 3.98, p = 0.046), but final outcomes showed no significant difference in nerve function (median follow-up = 6.0 months). Binary logistic regression identified age (odds ratio [OR] = 1.3, p = 0.028), HRUS (OR = 10.6, p = 0.035), and injured nerve (OR = 3.1, p = 0.022) as independent outcome predictors.
Interpretation:
Good functional recovery in pediatric patients with peripheral nerve injury was demonstrated. HRUS-guided treatment and age < 9 years were independent predictors of favorable outcome. These findings support HRUS as a valuable, noninvasive tool for guiding pediatric nerve injury management.
