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Surgery
Research
Outcome of surgical repair of adult digital nerve injury: a systematic review
  1. Rebecca L E Dunlop1,
  2. Justin Conrad Rosen Wormald2,
  3. Abhilash Jain3,4
  1. 1 Department of Hand Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK
  2. 2 Plastic, Reconstructive and Burns Surgery, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
  3. 3 Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  4. 4 Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Professor Abhilash Jain; ajainuk{at}aol.com

Abstract

Objectives A systematic review to assess the evidence supporting surgical repair of digital nerve injury versus no repair in adults in terms of clinical outcomes.

Design A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review with methodology based on the Cochrane Handbook of Systematic Reviews of Interventions.

Data sources Databases included OvidMEDLINE, EMBASE, AMED, clinicaltrials.gov and the Cochrane Database of Systematic Reviews, searched from inception until 10 November 2018.

Eligibility criteria Adult digital nerve injury in which either direct repair or no repair was undertaken and an outcome measure was recorded.

Data extraction and synthesis Study data extracted included demographics, injury type and extent, timing, treatment details, outcome data and time points, adverse outcomes, hand therapy and return to work. The National Institute of Health quality assessment tool for case series was used to assess risk of bias.

Results Thirty studies were included. One compared surgical repair with non-repair. All studies were case series of between 15 and 110 nerve injuries, with heterogeneous patient, injury and treatment characteristics. Two studies detailed nerve repair without magnification. Static 2-point discrimination (s2PD) was the most commonly reported outcome measure. Return of protective sensation was achieved in most cases in the nerve repair and no nerve repair groups. Repair resulted in better s2PD than no repair, but <25% repaired nerves achieved normal levels. Adverse outcomes were similar between repair and no repair groups.

Conclusions Only level IV evidence is available to support surgical repair of digital nerves in adults. Return of normal sensibility is uncommon and almost all unrepaired nerves regained protective sensation by 6 months and all patients declined further surgery. There was no difference in adverse outcomes. There is currently a lack of high-quality evidence to support surgical repair of digital nerve injuries in adults and further research is needed.

PROSPERO registration number CRD42017065092.

  • digital nerve
  • nerve injury
  • nerve repair

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-025443

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    Footnotes

    • Twitter @JCRWormald

    • Contributors RLED carried out the literature search in association with Cornwall Health Library. RLED and JCRW screened the search results, AJ searched for additional studies, RLED performed data extraction and manuscript write-up, JCRW compiled the references and JCRW and AJ made improvements and corrected the manuscript.

    • Funding JCRW is an NIHR Academic Clinical Fellow. This research is supported by the National Institute for Health Research (NIHR) infrastructure at NDORMS. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. No funding was directly received for the development of this manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.

    • Patient consent for publication Not required.