51 Can We Predict the Outcome of Traumatic Paediatric Peripheral Nerve Injuries Using Ultrasound and Nerve Conduction Studies? a Case series

Management of paediatric peripheral nerve injury varies across clinical practice. Clinical examination is favoured by some, whilst others use a combination of methods such as nerve conduction studies (NCS) and ultrasound studies (US). This case series reviewed outcomes of paediatric peripheral nerve injuries, which underwent both investigations, to establish optimal diagnosis and management of paediatric peripheral nerve injury. A retrospective case series of eighteen paediatric traumatic peripheral nerve injuries presenting at a tertiary referral centre between January 2019 – August 2023 was completed. Data was collected regarding the type and date of injury, immediate intervention, investigation dates and findings, and management. Eighteen traumatic upper limb injuries which had both US and NCS were included. The ulnar nerve was most injured, and half of nerve injuries were caused by supracondylar fractures. All cases had NCS completed before US. Fourteen NCS cases showed axonotmesis and four showed neurotmesis. Nerve continuity was visualised on US in eleven cases. Ten patients were managed conservatively. Two cases underwent surgical intervention, where US showed either scarring or non-visualisation. NCS in paediatric peripheral nerve injury often shows high grade injury; with axonotmesis commonly reported. Most US conducted at similar timepoints to NCS show nerve continuity. Results suggest that US, in addition to NCS, can aid management of peripheral nerve injury and may reduce the need for surgical intervention. Delays in completing US may impact decisions to wait for spontaneous recovery. Future studies should utilise multi-institutional datasets to compare and establish suitable timeframes for injury-specific interventions to aid surgical decision making.