Brachial plexus gunshot injury in an infant.

We present the case of an infant with a gunshot lesion in the brachial plexus. Intraoperative nerve action potential recordings suggested posterior cord neurolysis and medial and lateral cord grafting. After 3 years' follow-up complete recovery of motor and sensory function was seen as a result of immense nerve regeneration capability and brain plasticity. According to our knowledge this is the first reported case of such a mechanism of injury in an infant.

Hook-rod with pedicle screw fixation for unstable spinal fracture. Technical note.

A technique is described in which spinal fracture repositioning, decompression, and stabilization are achieved by a combination of hook-rod and pedicle screw fixation. This straightforward technique is useful for performing acute decompression in patients with partial neurological deficits and multisystem injuries. A laminectomy allows for placement of a stiffer fixation system, and it improves the insufficient canal clearance obtained when performing annulotaxis alone.

The anatomy of the Berrettini branch: implications for carpal tunnel release.

OBJECT: Dissections were performed in 100 fresh cadaver palms to determine the frequency with which superficial palmar communication between the median and ulnar nerves occurs and to what extent it might incur iatrogenic injury during endoscopic carpal tunnel release. METHODS: Superficial palmar communication between the median and ulnar nerves was present in 81% of the dissected hands. Superficial palmar communication, also known as the Berrettini branch, has been classified into four distinct types by Ferrari and Gilbert. Twelve hands were classified as Group 1 (communication in an oblique course from the ulnar to the median nerve originating >4 mm above the distal margin of the transverse carpal ligament [TCL]), 16 hands were classified as Group 2 (communication parallel to the distal margin of the TCL), and 53 hands were classified as Group 3 (communication in an oblique course from the ulnar nerve to the third common digital nerve, originating below the distal margin of the TCL). No hand fit the Group 4 classification (atypical communication). CONCLUSIONS: The Berrettini branch can be considered a normal anatomical finding. In 28% of the hands in this study, the branch was proximal to the edge of the distal ligament and, therefore, prone to iatrogenic injury in both one-portal and two-portal endoscopic surgery.

Evaluation of functional nerve recovery shows that allogeneic nerve graft treated with ICAM-1 and LFA-1 mAbs can be good alternative to syngeneic graft.

The objective of the study is to establish recovery results of tibial nerve defects reconstructed using allogeneic and xenogeneic graft, in host immunosuppressed with Intercellular Adhesion Molecule-1 (ICAM-1) and Lymphocyte Function Antigen-1 (LFA-1) monoclonal antibodies (mAbs). A pilot study was conducted in fifteen Fischer rats by forming a 1 cm right tibial nerve gap, then reconstructing it with 1.2 cm long grafts, namely, Wistar allogeneic, Black mouse xenogeneic, and syngeneic (n = 5/group). The main study included forty-eight rats allocated to the following groups (n = 12/group): 1) Allograft without treatment as control group. 2) Allograft with intraperitoneal ICAM-1 and LFA-1 mAbs treatment. 3) Allograft preserved in Belzers' solution including ICAM-1 mAbs plus standard intraperitoneal treatment. 4) Syngraft as benchmark. At 3, 6 and 9 weeks postengraftment walking track analysis was performed and expressed as Tibial Functional Index (TFI). Motor and compound nerve action potential across the graft conduction velocities were measured at week 10. Xenograft did not show any functional recovery and was therefore excluded from main study. However, pilot and main study results showed recovery results in both treated allogeneic groups and were comparable to benchmark syngraft. Therefore, allogeneic nerve graft could be an alternative in peripheral nerve reconstruction and spinal cord grafting.

The value of an operating microscope in peripheral nerve repair. An experimental study using a rat model of tibial nerve grafting.

The aim of this study was to test the hypothesis that the use of an operating microscope improves the results of peripheral nerve repair. Tibial nerve grafting was carried out on 48 Fischer rats divided into 2 groups: in one, a loupe was used, and in the other a surgical microscope. At 5 months after grafting, recovery was evaluated by functional, electromyographic, and morphometric tests. The mean motor nerve conduction velocity was 26.77 +/- 9.37 m/sec in the group where the loupe was used compared with 44.19 +/- 11.36 m/s when the microscope group was used. The soleus muscle weight and the diameter of myelinated fibres also confirmed better regeneration in the microscope group. These results clearly indicate that it is essential to use the microscope for peripheral nerve repair.