The etiology, presentation and management of acute upper limb traumatic peripheral nerve injuries among urban dwellers in Kenya

Abstract

This was a descriptive prospective study to determine the etiology. presentation and management of acute upper limb traumatic peripheral nerve injuries among urban dwellers in Kenya as seen at Kenyatta National Hospital. The study was done at Kenyatta National Hospital over a period of three months between April and June 2007 following an approval by the Hospital ethical committee. A total of sixty patients. fulfilling the inclusion criteria, were recruited into the study on presentation at the hospital's accident and emergency department or in the orthopedic wards once admitted. Consent was obtained from each patient recruited. History of the injuries was taken followed by a thorough physical examination. The findings were recorded in a pre-tested questionnaire . .(If The data was analyzed by descriptive statistics and reported in frequency tables and graphs. The inferential statistics such as chi-square, logic analysis and spearman' s correlation were used. These were done using the Statistical Package for Social Sciences (SPSS 1.2) and Excel. Males were most affected accounting for 83.3% of all cases seen. The mean age of patients recruited was 35.7 years. The most common age group involved was between 20 - 29 year~ (40.3%) followed by the age group 30 - 49 years (31.5%). Lower level of education was noted to significantly contribute to nerve injuries especially in industrial set ups. Majority of the patients (28.3%) presented to the hospital within 6 hours of injury. Those who presented late were mainly referral cases. Road traffic accidents were the most common cause of upper limb peripheral nerve injuries accounting for 27.9% followed by industrial accidents and assault injuries (23.3% and 21.3% respectively). Hand injuries were the most prevalent presentation at 40% followed by forearm at 28.3%. Open injuries accounted for 66%of all the cases, of these 88.1% were due to cut wounds while penetrating injuries formed the remaining 11.9%. Thirty three (33%) percent of the cases were blunt injuries. Most of the blunt injuries (57.9%) were associated with bone fractures. In 33.9% of the cases the digital nerves were involved while 32.2% were ulna nerve and 22% were median nerve injuries. The radial nerve. brachial plexus and axillary nerve injuries accounted for 20.3%, 8.5% and 5.1% respectively. Mixed nerve lesions were noted in 41.6% of all the cases. The most common combination was median and ulnar nerves accounting for 72% of these cases. All the patients had x-rays done as the primary investigation. No confirmatory investigation was done to diagnose nerve injury. Surgical toilet alone was the most common management offered (66.7% of the cases) while primary nerve repair was offered to only 15.8% , of the cases. Delayed nerve repairs were carried out in 5.3% of the cases. All patients with hand injuries were referred to the occupational therapy department for rehabilitation. The study was ended once the patient was discharged from the ward .