Peripheral Nerve Injury After Elbow Arthroscopy: An Analysis of Risk Factors

Tratamiento artroscópico de la rigidez del codo: artrofibrosis

“…Estas lesiones están limitadas en la literatura a unas pocas series de casos publicados en los últimos años (22,23) , por lo que su incidencia exacta no se conoce y se cree que es mayor de la que está registrada. En un estudio reciente de Jinnah et al se registran lesiones nerviosas periféricas en 12 de 227 pacientes, siendo 10 (4,4%) menores (transitorias) y 2 (0,9%) mayores (permanentes), que requirieron reparación nerviosa (24) . En cuanto a la rigidez de codo preoperatoria, la contractura en flexión se ha detectado como un Tabla 1.…”

Editorial Commentary: Volition, Fear, and Faith: Elbow Arthroscopy and Nerve Injury

“…Jinnah et al 1 found a 4.4% incidence of minor and 0.9% incidence of major nerve complications in their retrospective review of 10 years and 227 surgeries among 6 surgeons. Similarly, transient nerve injuries were reported in 4.2% of 24 cases by Andrews 4 Regarding what would likely be reported as a major nerve complication, insurance database reviews by Werner et al 5 and Leong et al 6 have identified a 1.2% rate of nerve injury on ICD-9 coding among 2,785 patients and 1.26% rate of reoperation for nerve injuries per CPT coding of 4,127 elbow arthroscopies.…”

“…8,9 This study reports a statistically insignificant 13.3% incidence of nerve injury with concurrent procedures, but do not let underpowered statistics get in the way of good judgment, as Leong et al find more risk for nerve injury with more complex cases by reviewing 4,127 arthroscopies. 1,6 Loss of bony landmarks by obesity can make precise portal placement more difficult. Just as many studies are identifying increased complications with obesity, Werner et al 5 specifically considered obesity as a risk factor, treated body mass index (BMI) as a categorical value, and found a statistically significant increase for nerve injury with obesity (BMI >30) and an odds ratio of 5.4 compared with nonobese patients.…”

“…This study treated BMI as a continuous variable and found a statistically significant, but clinically insignificant, increase of BMI in the injured group. 1 Jinnah et al find that neither surgeon experience, measured by years since board certification, nor surgeon volume correlates with risk of nerve injury. Jinnah et al 1 categorize 3 surgeons as high volume with only 6 cases per year and 3 low-volume surgeons with less than 1½ cases per year.…”

“…1 Jinnah et al find that neither surgeon experience, measured by years since board certification, nor surgeon volume correlates with risk of nerve injury. Jinnah et al 1 categorize 3 surgeons as high volume with only 6 cases per year and 3 low-volume surgeons with less than 1½ cases per year. Kelly et al 3 reported on 2 high-volume surgeons, each averaging 11.6 cases per year over 18 years, and 10 low-volume surgeons each with less than 1 case per year.…”