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Eur J Pediatr Surg 2023; 33(04): 319-327
DOI: 10.1055/s-0042-1751221
Original Article

Detection of Traumatic and Postoperative Nerve Lesions following Upper Extremity Fractures in a Pediatric Cohort Using MR Neurography

Stefan Sondermann 
1   Department of Neuroradiology, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
,
Tobias Bäumer
2   Institute of System Motor Science, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
,
Joachim Suss
3   Department of Pediatric Surgery, Wilhelmstift Catholic Children's Hospital Hamburg, Hamburg, Germany
,
Boy Bohn
4   Department of Orthopedics and Trauma Surgery, BG Trauma Hospital Hamburg, Hamburg, Germany
,
Katharina Fieseler
1   Department of Neuroradiology, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
,
Peter Schramm
1   Department of Neuroradiology, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
,
Ludger Tueshaus
5   Department of Pediatric Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
,
Tobias Boppel
1   Department of Neuroradiology, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Germany
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Abstract

Introduction Fractures of the upper extremity are common traumatic injuries in children. Nerve lesions are a rare but typical complication of these fractures. Additional to physical, electrophysiological, and sonographic examinations, magnetic resonance neurography (MRN) can be used to assess the degree and exact localization of nerve damage. This retrospective study was conducted to evaluate the potential role of this examination technique for children and to test a proposed MRN classification of traumatic nerve injury according to Chhabra in a pediatric cohort.

Materials and Methods Pediatric patients undergoing MRN for traumatic nerve injury from January 2016 to December 2020 were retrospectively identified. A total of 12 consecutive patients with sufficient clinical data, an MRN, and if available follow-up examination were enrolled and analyzed.

Results In 10 of 12 cases one or more nerve lesions could be identified by MRN using the classification proposed by Chhabra et al. MRN was used to assess nerve injuries, imaging results were compared with clinical course. Clinical follow-up examinations of 10 patients showed an overall good clinical recovery, even in one case with severe trauma and nerve surgery.

Conclusion MRN as a noninvasive procedure can help in the evaluation of nerve injury, especially for the identification of lower grade nerve damage and to objectify suspected nerve damage in case of uncertain clinical examination results; thus, can help in decision making whether surgical revision or conservative treatment is preferable.

Keywords

nerve injury - magnetic resonance neurography - fractures - traumatic nerve injury

Ethical Approval

The ethics committee at the University of Lübeck, Germany, approved the study (19–385).


Authors' Contribution

SS, TB, LT contributed toward conception and design. SS with support from TB, KF, BB, JS, and LT did the acquisition of data. SS, TB, LT, PS, and TB analyzed and interpreted the data. SS and TB with support from LT, TB, and PS drafted the manuscript. All authors made substantial contribution to the manuscript and gave approval to the final version before submission.




Publication History

Received: 05 April 2022

Accepted: 17 May 2022

Article published online:
19 July 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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