2. NERVE & TENDON injuries
Dr.H.Saremi
Orthopaedic surgeon, Hand & Shoulder fellowship
Hamedan university of medical sciences
Besat Hospital

3. Peripheral nerve injury
Common
Results of remain modest(only 50% regaining usefull function

4. Internal topograpy
Sanderland1945,a complexnetwork of branching and intermingling fascicles that consantly change throughout the course of the nerve
Complex in proximal
Distal fascicles can be dissected over long distances before merging occurs

6. Neuronal degeneration and regeneration
Any part of the neuron detached from its nucleous degenerates and is destroyed by phagocytosis
Faradic stimulation can be obtained for periods of 18-72h

7. Neuronal degeneration and regeneration
Fragmentation and shrinkage
Clearing of axonal debries is complete after days
Axonal sprouting may occur within the first 24 h after injury
Stamp neuroma or neuroma in continuity

8. Classification of nerve injuries(seddon1943)
Neuropraxia :edema or breakdown of a localized segment of the myelin sheath,recovery in afew days or weeks
Axonotemesis:breakdown of the axon and wallerian degeneration .schwan cell and endoneurial tubes preserved
Neurotmesis complete anatomical severance of the nerve

9. Classification of nerve injuries(sunderland1951)

11. Assessment after recovery

12. Factors that influence regeneration after neurorraphy
Age
Gap between nerve ends
Delay between time of the injury and repair
Level of injury
Condition of the nerve ends
Experience and technique of the surgeon

13. technique

14. Type of injuries

15. Radial nerve

16. Radial nerve
Results of repair:89%proximal muscles,63% all musclesm,36%fine control of extensores
Critical limit of delay:15 m no motor recovery,PIN9 m

17. Ulnar nerve

23. Ulnar nerve
Results or repair:78:% useful motor recovery,5%independent motion of interossei,30%s3
Critical limit of delay9m in high lesions 15 m in low lesions,sensory 29m

24. Nerve transfer

25. Median nerve

26. Median nerve
Results of repair:82%-90%good and fair motor recovery,97% sensory recovery
Critical time of delay:sensory and intrinsic muscles:9 m in high lesions,12 m in low lesions

27. Flexor tendon injuries

28. Flexor tendon injuries

29. Flexor tendon injuries

30. Flexor tendon injuries

31. Flexor tendon injuries Post operative care
Kleinert:active ex passive flx
Duran: controled passive motion with dorsal blocking of the finger

32. Flexor tendon injuries

33. Extensor tendon injuries

34. THANK YOU