Peripheral nerve injuries in a Third World country.
This five year prospective research study reports on 74 patients with injuries to 89 nerve segments. Ninety eight pc of the injuries were caused by penetrating and only four pc by blunt trauma; 5.4 pc of the patients presented directly to use as emergencies while the remainder presented after an average delay of 23 weeks. Clavioaxillary (40.5 pc) and upper limb (41.9 pc) neurological lesions constituted the bulk of the injuries involving a predominantly younger male population (96 pc). Brachial plexus and proximal upper limb injuries often involved more than one segment of a nerve, 34.9 pc of the lesions were axonotmetic, requiring external and internal neurolyses, while 65.1 pc were neurotmetic, for which neurorrhaphy (in four patients) or sural nerve interposition grafting was performed. The follow up compliance was poor. At two years, with a 55.4 pc re-attendance rate, improvement to at least grade three or more, was achieved in 50 pc of the attending patients, neurolysed for axonotmesis and in 53.8 pc of the neurotmetic patients who required sural grafts. At five years the re-attendance rate had fallen to 16.2 pc and this did not offer a realistic clinical and statistical generalisation of the results.