Missile-caused median nerve injuries: results of 81 repairs.
BACKGROUND
Missile-caused median nerve injuries have rarely been reported in current literature. We present repair outcome for all median nerve injuries in which the median nerve was severed either by missile injury or secondarily in the subsequent resection of a neuroma in continuity.


METHODS
Prospective study included 81 casualties with proximal, intermediate, or distal complete median nerve lesions, repaired by nerve graft or direct suture. Final outcome was defined at least 4 years postoperatively, on the basis of motor recovery, sensory recovery, neurophysiological recovery, and patient's judgment on the outcome, each estimated by 0 to 5 points and according to the total sum, as poor, insufficient, good, or excellent. The last 2 modalities were considered to be successful.


RESULTS
Successful outcome was obtained in 68.7% of distal, in 33.3% of intermediate, and in 10% of proximal repairs. Average outcomes were good, insufficient, and poor, respectively (P < .001). Nerve defect and preoperative interval were both significantly shorter on average for patients with successful outcome than for those with unsuccessful outcome (P < .001 and P = .007, respectively), but only preoperative interval and height of repair were independent predictors for successful outcome. Age of patient, associated ulnar nerve complete lesion, and manner of repair did not influence the outcome significantly (P > .05).


CONCLUSIONS
The level of repair, duration of preoperative interval, and length of nerve defect significantly influence outcome after median nerve repair, but only level of repair and duration of preoperative interval were independent predictors for successful outcome.
Roganovic
Zoran
Z
Neurosurgical Department, Military Medical Academy, Belgrade, Serbia and Montenegro 11077. roganovic@yubc.net
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008475:Median Nerve / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D020423:Median Neuropathy / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology; D012678:Sensation Disorders / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D019737:Transplants / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014459:Ulnar Nerve / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D020424:Ulnar Neuropathies / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D014948:Wounds, Gunshot / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D015022:Yugoslavia