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Minerva Medicolegale 2019 December;139(1-4):1-9

DOI: 10.23736/S0026-4849.20.01786-1

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Medico legal aspects of misdiagnosis of acute peripheral nerve injury: risk factor analysis and literature review

Nicola FELICI 1, Simona ZAAMI 2 , Simona NAPOLETANO 3, Matteo ORNELLI 1, Enrico MARINELLI 2

1 Unit of Reconstructive Surgery of the Limbs, San Camillo-Forlanini Hospital, Rome, Italy; 2 Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy; 3 ASL Latina, Latina, Italy



Early treatment of peripheral nerve cutting injuries allows for better functional recovery than that achievable with late repairs. For this reason, immediate diagnosis of nerve damage is very important, through an accurate physical examination of the injured segment, motor function and sensitivity. An misdiagnosed lesion of a peripheral nerve determines the need to perform a repair by nerve grafts, instead of a direct nerve coaptation, and in some cases, if elapsed time exceeds 12 months from the moment of damage, the functional recovery, both motor and sensory, may be incomplete or absent. This study presents a review of the literature and a meta-analysis on a group of 47 patients with peripheral nerve cutting injuries of the limbs, not diagnosed upon first access to an emergency department. The purpose of the work was to identify what are the risk factors for failure to diagnose. From the analysis of the data it emerged that the wounds with the greatest risk of misdiagnosis are those of small dimensions, caused by glass, which involve the ulnar nerve and which are not examined in the emergency room by an experienced plastic surgeon or orthopedist. An early diagnosis, already carried out in emergency areas, allows for an optimal timing in surgical restoration, can reduce the impairment resulting from the injuries and it is bound to positively influence the medicolegal developments lessening the risk of malpractice-related claims.


KEY WORDS: Peripheral nerve injuries; Diagnostic errors; Risk factors

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