Nerve transfers for femoral nerve palsy: an updated approach and surgical technique

2021 ◽  
pp. 1-11
Author(s):  
Blair R. Peters ◽  
Austin Y. Ha ◽  
Amy M. Moore ◽  
Thomas H. Tung
Keyword(s):  
Pain Score ◽  
Nerve Palsy ◽  
Femoral Nerve ◽  
Surgical Techniques ◽  
Nerve Transfer ◽  
Knee Extension ◽  
Lower Extremity Function ◽  
Nerve Decompression ◽  
Nerve Transfers ◽  
Femoral Nerve Palsy

OBJECTIVE Femoral nerve palsy results in significant impairment of lower extremity function due to the loss of quadriceps muscle function. The authors have previously described their techniques utilizing the anterior obturator and sartorius nerves for transfer in cases of femoral nerve palsy presenting within 1 year of injury. In the current study, the authors discuss their updated techniques, results, and approach to partial and complete femoral nerve palsies using femoral nerve decompression and nerve transfers. METHODS They conducted a retrospective review of patients with femoral nerve palsies treated with their technique at the Washington University School of Medicine in 2008–2019. Primary outcomes were active knee extension Medical Research Council (MRC) grades and visual analog scale (VAS) pain scores. RESULTS Fourteen patients with femoral nerve palsy were treated with femoral nerve decompression and nerve transfer: 4 with end-to-end (ETE) nerve transfers, 6 with supercharged end-to-side (SETS) transfers, and 4 with ETE and SETS transfers, using the anterior branch of the obturator nerve, the sartorius branches, or a combination of both. The median preoperative knee extension MRC grade was 2 (range 0–3). The average preoperative VAS pain score was 5.2 (range 1–9). Postoperatively, all patients attained an MRC grade 4 or greater and subjectively noted improved strength and muscle bulk and more natural gait. The average postoperative pain score was 2.3 (range 0–6), a statistically significant improvement (p = 0.001). CONCLUSIONS Until recently, few treatments were available for high femoral nerve palsy. A treatment strategy involving femoral nerve decompression and nerve transfers allows for meaningful functional recovery and pain relief in cases of partial and total femoral nerve palsy. An algorithm for the management of partial and complete femoral nerve palsies and a detailed description of surgical techniques are presented.

scholarly journals Femoral nerve decompression and sartorius-to-quadriceps nerve transfers for partial femoral nerve injury: a cadaveric study and early case series

2020 ◽  
pp. 1-8
Author(s):  
Colin W. McInnes ◽  
Austin Y. Ha ◽  
Hollie A. Power ◽  
Thomas H. Tung ◽  
Amy M. Moore
Keyword(s):  
Femoral Nerve ◽  
Case Series ◽  
Knee Extension ◽  
Nerve Fibers ◽  
Cadaveric Study ◽  
Lower Limbs ◽  
Sartorius Muscle ◽  
Nerve Injuries ◽  
Nerve Decompression ◽  
Nerve Transfers

OBJECTIVEPartial femoral nerve injuries cause significant disability with ambulation. Due to their more proximal and superficial location, sartorius branches are often spared in femoral nerve injuries. In this article, the authors report the benefits of femoral nerve decompression, demonstrate the feasibility of sartorius-to-quadriceps nerve transfers in a cadaveric study, describe the surgical technique, and report clinical results.METHODSFour fresh-frozen cadaveric lower limbs were dissected for anatomical analysis of the sartorius nerve. In addition, a retrospective review of patients with partial femoral nerve injuries treated with femoral nerve decompression and sartorius-to-quadriceps nerve transfers was conducted. Pre- and postoperative knee extension Medical Research Council (MRC) grades and pain scores (visual analog scale) were collected.RESULTSUp to 6 superficial femoral branches innervate the sartorius muscle just distal to the inguinal ligament. Each branch yielded an average of 672 nerve fibers (range 99–1850). Six patients underwent femoral nerve decompression and sartorius-to-quadriceps nerve transfers. Four patients also had concomitant obturator-to-quadriceps nerve transfers. At final follow-up (average 13.4 months), all patients achieved MRC grade 4−/5 or greater knee extension. The average preoperative pain score was 5.2, which decreased to 2.2 postoperatively (p = 0.03).CONCLUSIONSFemoral nerve decompression and nerve transfer using sartorius branches are a viable tool for restoring function in partial femoral nerve injuries. Sartorius branches serve as ideal donors in quadriceps nerve transfers because they are expendable, are close to their recipients, and have an adequate supply of nerve fibers.

scholarly journals Modification of obturator to femoral nerve transfer for femoral nerve palsy

2020 ◽  
Vol 102 (3) ◽  
pp. e70-e72
Author(s):  
DJ Graham ◽  
BS Sivakumar ◽  
R Lawson
Keyword(s):  
Poor Prognosis ◽  
Nerve Palsy ◽  
Femoral Nerve ◽  
Nerve Transfer ◽  
Delay In Diagnosis ◽  
Femoral Nerve Palsy ◽  
Unusual Injury

Postoperative femoral nerve palsy with nerve division is a potentially devastating complication with a poor prognosis, especially when there is a delay in diagnosis. We present a novel ‘belt and braces’ approach for managing this unusual injury, using a modification of a nerve transfer, which has only been previously reported in the literature three times to our knowledge.

Sciatic-to-Femoral Nerve End-to-End Coaptation for Proximal Lower Extremity Function in Patients With Acute Flaccid Myelitis: Technical Note and Review of the Literature

2021 ◽  
Author(s):  
Daniel Lubelski ◽  
Zach Pennington ◽  
Sami Tuffaha ◽  
Amy Moore ◽  
Allan J Belzberg
Keyword(s):  
Sciatic Nerve ◽  
Lower Extremity ◽  
Femoral Nerve ◽  
Nerve Transfer ◽  
Knee Extension ◽  
Acute Onset ◽  
Technical Note ◽  
Lower Extremity Function ◽  
Acute Flaccid Myelitis ◽  
End To End

Abstract BACKGROUND Acute flaccid myelitis (AFM) is an acute-onset anterior horn disease resulting in flaccid paralysis of extremities, trunk, facial, and cervical musculature in children following upper respiratory or gastrointestinal viral illness. Nerve transfer procedures have been shown to restore function. OBJECTIVE To present a technical description of sciatic-to-femoral nerve transfers in 4 children with AFM. METHODS Retrospective review of relevant cases was performed. RESULTS A total of 4 cases are presented of young children with persistent quadriparesis in the setting of AFM, presenting between 4 and 15 mo following initial diagnosis. Electromyography showed denervation of muscles innervated by the femoral nerve, with sparing of the sciatic distribution. The obturator nerve was also denervated in all patients. We therefore elected to pursue sciatic-to-femoral transfers to restore active knee extension. These transfers involved end-to-end coaptation of a sciatic nerve fascicle to the femoral nerve motor branches supplying quadriceps muscles. CONCLUSION We present technical descriptions of bilateral sciatic-to-femoral nerve neurotization for the restoration of quadriceps function in 4 patients with AFM. The sciatic nerve fascicles are a reasonable alternative donor nerve for patients with proximal muscle paralysis and limited donor options in the lower extremity.

Radial Nerve Palsy: Nerve Transfer Versus Tendon Transfer to Restore Function

Hand ◽  
2021 ◽  
pp. 155894472098812
Author(s):  
J. Megan M. Patterson ◽  
Stephanie A. Russo ◽  
Madi El-Haj ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Radial Nerve ◽  
Tendon Transfer ◽  
Nerve Palsy ◽  
Nerve Transfer ◽  
Pinch Strength ◽  
Radial Nerve Palsy ◽  
Nerve Injuries ◽  
Tendon Transfers ◽  
Nerve Transfers ◽  
Transfer Group

Background: Radial nerve injuries cause profound disability, and a variety of reconstruction options exist. This study aimed to compare outcomes of tendon transfers versus nerve transfers for the management of isolated radial nerve injuries. Methods: A retrospective chart review of 30 patients with isolated radial nerve injuries treated with tendon transfers and 16 patients managed with nerve transfers was performed. Fifteen of the 16 patients treated with nerve transfer had concomitant pronator teres to extensor carpi radialis brevis tendon transfer for wrist extension. Preoperative and postoperative strength data, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and quality-of-life (QOL) scores were compared before and after surgery and compared between groups. Results: For the nerve transfer group, patients were significantly younger, time from injury to surgery was significantly shorter, and follow-up time was significantly longer. Both groups demonstrated significant improvements in grip and pinch strength after surgery. Postoperative grip strength was significantly higher in the nerve transfer group. Postoperative pinch strength did not differ between groups. Similarly, both groups showed an improvement in DASH and QOL scores after surgery with no significant differences between the 2 groups. Conclusions: The nerve transfer group demonstrated greater grip strength, but both groups had improved pain, function, and satisfaction postoperatively. Patients who present early and can tolerate longer time to functional recovery would be optimal candidates for nerve transfers. Both tendon transfers and nerve transfers are good options for patients with radial nerve palsy.

Femoral Nerve Palsy Following Total Hip Arthroplasty: Incidence and Course of Recovery

2018 ◽  
Vol 33 (4) ◽  
pp. 1194-1199 ◽  
Author(s):  
Andrew N. Fleischman ◽  
Richard H. Rothman ◽  
Javad Parvizi
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Nerve Palsy ◽  
Femoral Nerve ◽  
Total Hip ◽  
Femoral Nerve Palsy

scholarly journals Transient femoral nerve palsy in spica cast treatment for developmental dysplasia of the hip

2018 ◽  
Vol 40 (2) ◽  
Author(s):  
Luisella Pedrotti ◽  
Barbara Bertani ◽  
Gabriella Tuvo ◽  
Redento Mora ◽  
Mario Mosconi ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Femoral Nerve ◽  
Female Child ◽  
Plaster Cast ◽  
Developmental Dysplasia ◽  
Congenital Dislocation ◽  
X Rays ◽  
Spica Cast ◽  
Femoral Nerve Palsy ◽  
Previously Treated

A 4 months and half female child come to our attention for congenital dislocation of the left hip, previously treated in another hospital with abduction bracing, without satisfactory results. After progressive longitudinal bilateral traction, closed reduction under general anesthesia was performed and a spica cast was applied in the so-called human position. The patients remained in the spica cast for 6 weeks and then the plaster cast was renewed in narcosis for another 6 weeks. Once the second cast has been removed left femoral nerve palsy was detected. Orthopaedic treatment was interrupted and in 3 months the nerve completely recovered, while the hip was still stable. We followed the child regularly since then, she is now five years old, she is totally asymptomatic, X-rays shows a residual acetabular dysplasia, with no sign of avascular necrosis.

Spontaneous iliacus haematoma with femoral nerve palsy: an appeal to involve surgical teams early

2021 ◽  
Vol 14 (1) ◽  
pp. e239024
Author(s):  
Alexander M Crawford ◽  
Theodore T Guild ◽  
Brendan M Striano ◽  
Arvind G Von Keudell
Keyword(s):  
Nerve Palsy ◽  
Femoral Nerve ◽  
Surgical Decompression ◽  
Patient Benefit ◽  
Surgical Case ◽  
Compressive Neuropathy ◽  
Femoral Nerve Palsy ◽  
Surgical Teams ◽  
High Index Of Suspicion ◽  
Bridge Therapy

We report the case of a 68-year-old man who was placed on heparin as bridge therapy and subsequently developed an iliacus haematoma with associated femoral nerve palsy. His team involved the orthopaedic surgery team in delayed fashion after his symptom onset. Due to his active medical conditions, he did not undergo surgical decompression of his haematoma until late into his hospital course. Unfortunately, this patient did not regain meaningful function from his femoral nerve deficit. We believe this case highlights the high index of suspicion necessary for making this diagnosis as well as the repercussions of an untimely decompression for this acute, compressive neuropathy. Although we are surgeons and this is a surgical case, we hope to publish this case in a medical journal to raise awareness that surgical decompression does have a role in this diagnosis and should ultimately be pursued early in its course for optimal patient benefit.

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