Radial nerve injuries are often associated with humeral shaft fractures. The results of treatment of these injuries, by contemporary surgical approaches, remain diverse. In this paper we presented the outcomes and analyzed the patient, clinical, and surgical procedure related characteristics and factors that may influence the outcome overall, in 77 patients treated at Clinic for Neurosurgery, Clinical Center of Serbia during a 20 years period. The nerve injuries were verified by US and EMNG. The majority of patients were treated by neurolysis or sural nerve grafting, while only few were treated by direct suture. The final recovery was evaluated by muscle strength assessment and classified using MRC. We analyzed extension of the wrist, extension of the fingers including the thumb, and abduction of the thumb. There was a significant statistical difference in MRC grade following the treatment. The total rate of useful functional recovery was achieved in 69 (89.61%) out of all studied patients, out of whom 20 (28.99%) achieved excellent recovery, 26 (37.68%) achieved good recovery and 23 (33.33%) achieved fair recovery. Only 8 (10.39%) out of all studied patients achieved poor recovery. The injured nerves, that were preserved in continuity, acquired by a low-energy trauma, and treated earlier than the 6 months were associated with better functional outcome following the surgery. In addition, there was a trend of better functional improvement with aging, keeping in mind that the old were subjected to lower energy trauma. The expectant management followed by surgery of radial nerve injury associated with humeral shaft fracture should be around 3 months, and the surgical nerve repair should not be performed later than the 6 months after injury. The energy of trauma may be a factor predicting patient's final recovery following the treatment.

Introduction: Radial nerve lesions present a clinical entity that may lead to disability, psychological distress, and job loss, and thus requires great attention. Knowledge of the etiology and exact mechanism of the nerve impairment is of great importance for appropriate management of these patients, and there are only a few papers that focused on these features in patients with surgically treated radial nerve lesions. The lack of studies presenting the etiology and injury mechanisms of surgically treated radial nerve lesions may be due to a relatively small number of specialized referral centers, dispersion to low-flow centers, and a greater focus on the surgical treatment outcomes.Aim: The aim of this study was to describe the etiological and epidemiological characteristics of patients with surgically treated radial nerve lesions of various origins.Methods: This retrospective study evaluated 147 consecutive patients with radial nerve lesion, treated in the department during the last 20 years, from January 1, 2001, until December 31, 2020.Results: The majority of patients belonged to the working population, and 70.1% of them were male. Most commonly, the etiology of nerve lesion was trauma (63.3%) or iatrogenic injury (28.6%), while the less common origin was idiopathic (4.1%) or neoplastic (4.1%). The most frequent location of the lesion was in the upper arm, followed by the elbow and forearm. Fracture-related contusion was the most common mechanism (29.9%), followed by postoperative fibrosis (17.7%), lacerations (17.7%), and compression (15.6%).Conclusion: Based on the fact that traumatic or iatrogenic injuries constitute the majority of cases, with their relevant mechanisms and upper arm predomination, it is crucial to raise awareness and understanding of the radial nerve injuries among orthopedic surgeons to decrease the numbers of these patients and properly preserve or treat them within the initial surgery.

Introduction: Rare peripheral nerve lesions comprise a histologically diverse group of neoplastic and non-neoplastic entities, characterized by infrequent occurrence and variable clinical presentations, presenting significant diagnostic and therapeutic challenges. This study presents eight cases of surgically treated rare peripheral nerve lesions with previously unreported long-term outcomes involving quality of life (QOL) assessment.Methods: A retrospective analysis was conducted on medical records from 2012 to 2022 to identify surgically treated cases of rare peripheral nerve lesions, selecting eight cases based on determined inclusion and exclusion criteria. Long-term outcomes and QOL were assessed 12 months post-surgery by patient examination, control imaging and self-reporting questionnaires.Results: The study included 4 benign (hemangioblastoma, angiomatoid fibrous histiocytoma, endometriosis (n=2)) and 4 malignant lesions (NTRK-rearranged spindle cell neoplasm, lymphoma, metastatic breast carcinoma (n=2)). Even though benign lesions generally presented with better outcomes, this was more closely related with level of nerve invasion and postoperative sequele, rather than presence of malignancy.Discussion: Because of a global lack of experience in handling such cases, this study aimed to present the cases we encountered in detail to serve as a basis for future literature reviews. The findings highlight the importance of individualized treatment strategies and long-term follow-up to optimize functional recovery and patient well-being.

Closed injuries to the peroneal nerve recover spontaneously in about a third of patients, but surgery may be needed in the remaining 2/3. The recovery after surgery is not always satisfactory and the patients may need an orthosis or a walking aid to cope with regular daily activities. This study aimed to evaluate the useful functional recovery and quality of life (QoL) in surgically treated patients with peroneal nerve (PN) injuries. The study involved 51 patients who have undergone surgical treatment due to PN injury in our department, within a 15-year period (2006–2020). Thirty patients (59%) were treated with neurolysis, 12 (23%) with nerve repair techniques, and 9 (18%) with tendon transfer (TT). Neurolysis is employed in the least extensive nerve injuries when nerve continuity is preserved and yields a motor recovery ratio of almost 80%. Nerve repairs were followed by 58.33% of patients achieving M3+ recovery, while 41.66% recovered to the useful functional state (M4 or M5) With the use of TTs, all patients recovered to the M3+, while 66.7% recovered to M4. All our results correspond to the results of previous studies. No statistically significant differences were found regarding the QoL of the groups. There is an apparent advantage of neurolysis, over nerve repair, over TT procedure, both in terms of useful functional recovery, and foot-drop-related QoL. However, when involving all aspects of QoL, these advantages diminish. The individual approach leads to optimal results in all groups of patients.

Cubital tunnel syndrome (CuTS) results from compression of the ulnar nerve at the elbow, resulting in pain, weakness, and numbness of the hand and forearm. This work describes the Quality of Life (QoL) and satisfaction after CuTS surgery and identifies the factors associated with those outcomes. This cross-sectional study included patients surgically treated for CuTS from January 2011 to September 2021 at the Neurosurgery Clinic of the Clinic Center in Serbia. The questionnaires applied were the Short Form 36 (SF-36), EuroQol instrument (EQ-5D-5 L), Bishop’s score and Patient-Rated Ulnar Nerve Evaluation (PRUNE). Sixty-two patients met the inclusion criteria. Bishop’s score: The median score was 10 (7.75–11), 54.8% of the cases presented excellent results. PRUNE: The median score for symptoms was 19 (6–38.5); for functional, was 14 (0.75–38); and the total was 18.25 (5.87–34.12). SF-36: The subscale with the best result was social functioning (84.68 ± 22.79). The scale with the worst value was emotional well-being (49.35 ± 7.87). EQ-5D-5L: Over 50% patients did not present problems with mobility, self-care, activity, and anxiety. The average EQ-VAS was 72.77 ± 18.70; and 0.72 ± 0.21 of the EQ-index, revealing a good QoL. Models for QoL and satisfaction: Ten models showed statistical significance. The variables with major involvement were body mass index and time evolution of the symptoms. Surgical decompression has proved to diminish the symptoms, improving QoL and satisfaction. Many fixed and changeable factors can affect the satisfaction levels after surgery.

Ulnar nerve injuries lead to severe intrinsic hand muscle dysfunction and major impairment of grip, pinch, and quality of life. Distal nerve transfers have been introduced to overcome the limitations of conventional repair and grafting by shortening the regeneration distance and improving reinnervation of intrinsic muscles. Can distal anterior interosseous nerve to deep motor branch of the ulnar nerve (AIN-to-UN-DMB) transfer restore intrinsic hand function and improve patient-reported quality of life in proximal ulnar nerve injuries? Twelve patients with proximal ulnar nerve injuries underwent distal AIN-to-UN-DMB transfer and were prospectively evaluated at 24 months postoperatively. Outcomes included intrinsic muscle strength graded by the BMRC scale, Egawa's sign, dynamometric assessment of grasp and pinch strength, and quality of life measured using the PNSQoL questionnaire. At final follow-up, intrinsic muscle strength improved markedly: 27 muscles achieved M4 and 14 achieved M3 strength, compared with universal M0 preoperatively. Grasp strength increased from a mean of 42.3% to 82.5%, and pinch strength from 37.4% to 80.5% of the contralateral hand. Overall satisfactory functional recovery was achieved in 87.5% of patients. Mean PNSQoL score improved significantly from 47.7 preoperatively to 74.4 postoperatively (p < 0.001), with all patients reaching very good or excellent quality-of-life categories. Distal AIN-to-UN-DMB transfer enables meaningful restoration of intrinsic hand function, substantial gains in grasp and pinch strength, and significant improvement in quality of life, representing an effective reconstructive option for proximal ulnar nerve injuries.