Peripheral nerve traction injury. Literature review

Abstract

Traction injury of the peripheral nerve (TIPN) is an injury that occurs as a result of stretching the nerve beyond its normal elastic properties. An analysis of the available literature has revealed the following. TIPN is the most common type of severe nerve injury in the setting of road traffic accidents, catatrauma, gunshot wounds, birth injuries, etc. The dynamics of TIPN during fast and slow stretching is the same and includes three phases: elastic, inelastic and tearing. The limits of elastic stretching of the nerve are determined by the degree of tortuosity of myelinated fibers and the elasticity of the connective tissue framework of the nerve. Stretching of the nerve beyond its elastic limits is characterized by rupture of axons and endoneurial sheaths, including at a considerable distance from the epicenter of pathomorphological changes, which determines the severity of the injury and the impossibility of effective nerve autoregeneration. The force of stretching and the direction of its application to the nerve trunk determine the severity of TIPN. The degree of nerve stretching varies along its length and reaches a maximum in the periarticular areas. A fairly moderate stretching of the nerve can lead to a noticeable change in the conductivity of electrical impulses. Unlike other localized types of nerve injury, the pattern of pathomorphological changes in TIPN includes various forms of damage to structural elements. Understanding the pathophysiology of TIPN is a prerequisite for the development of optimal treatment of this type of injury.