Traumatic Upper Extremity Nerve Lesions in Children: High-Resolution Nerve Ultrasound Can Improve Surgical Outcome

TL;DR

High-resolution ultrasound improves surgical outcomes for children with upper extremity nerve injuries by guiding treatment decisions.

Contribution

This study shows that high-resolution ultrasound is a valuable noninvasive tool for managing pediatric nerve injuries.

Findings

HRUS-guided treatment and age under 9 years were independent predictors of favorable outcomes.

Patients with HRUS evaluations had better functional recovery compared to those without.

Ulnar nerve was the most frequently affected in pediatric upper extremity injuries.

Abstract

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.

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.

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.

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.

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