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CC BY 4.0 · J Brachial Plex Peripher Nerve Inj 2025; 20(01): e87-e95
DOI: 10.1055/a-2716-2279
Original Article

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

Authors

  • Natalie Winter

    1   Department of Epileptology, Center for Neurology, Eberhard Karls University, Tuebingen, Germany
    2   Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tuebingen, Germany

  • Alexander Grimm

    1   Department of Epileptology, Center for Neurology, Eberhard Karls University, Tuebingen, Germany
    2   Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tuebingen, Germany

  • Johannes Heinzel

    3   Department of Hand-, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen, Eberhard Karls University, Tuebingen, Germany

  • Julia Wittlinger

    1   Department of Epileptology, Center for Neurology, Eberhard Karls University, Tuebingen, Germany

  • Josua Kegele

    1   Department of Epileptology, Center for Neurology, Eberhard Karls University, Tuebingen, Germany
    2   Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tuebingen, Germany

  • Justus Lieber

    4   Department of Pediatrics V, Pediatric Surgery and Pediatric Urology, Eberhard Karls University, Tuebingen, Germany

  • Cristian Urla

    4   Department of Pediatrics V, Pediatric Surgery and Pediatric Urology, Eberhard Karls University, Tuebingen, Germany

  • Martin Ulrich Schuhmann

    5   Department of Neurosurgery and Neurotechnology, Section of Pediatric Neurosurgery, Eberhard Karls University, Tuebingen, Germany

  • Helene Hurth 

    5   Department of Neurosurgery and Neurotechnology, Section of Pediatric Neurosurgery, Eberhard Karls University, Tuebingen, Germany

Funding The project was financially supported by the TÜFF program of the Medical Faculty at the Eberhard Karls University Tübingen (3054-0-0).
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Abstract

Background

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.

Methods

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.

Results

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 (χ2 = 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.

Interpretation

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.

Keywords

nerve injury - high-resolution ultrasound - nerve trauma - outcome predictors - nerve repair


Publication History

Received: 29 July 2025

Accepted: 03 October 2025

Article published online:
24 October 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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