Clinical Presentation
The case described [PMID:29697439] involved a self-inflicted stab wound causing a complete rupture of the femoral nerve at the pelvic level, highlighting the potential for such traumatic injuries.
Management
In an anatomical feasibility study [PMID:36534103], selective transfer of motor branches (gracilis to rectus femoris, adductor longus to vastus medialis, and adductor magnus to vastus intermedius) demonstrated sufficient nerve overlap without tension, suggesting potential for improved motor function post-injury.
Histological evaluation in cadaveric studies [PMID:36534103] showed axon counts of 598 ± 83 in the gracilis branch, closely matching the 709 ± 151 in the rectus femoris branch, indicating a viable donor nerve option.
In this case report [PMID:29697439], a complete rupture of the femoral nerve was successfully treated with a sural nerve cable graft, leading to near-normal recovery of sensorimotor function postoperatively.
In an anatomical feasibility study [PMID:22821710], direct neurorrhaphy between the motor branches of the obturator nerve (supplying gracilis and adductor longus muscles) and the motor portion of the femoral nerve was demonstrated to be possible without tension in cadavers, indicating potential clinical application for managing femoral nerve injuries.
The study [PMID:22821710] highlights that accessing the femoral nerve and the motor branches of the obturator nerve in the thigh is straightforward, contrasting with more challenging pelvic approaches, thus simplifying surgical management of femoral nerve injuries.
Prognosis & Follow-up
While the anatomical feasibility [PMID:36534103] suggests potential benefits, the study did not evaluate clinical outcomes such as patient mobility (e.g., rising, squatting, climbing stairs), highlighting the need for prospective clinical trials.
The patient in this case [PMID:29697439], described as otherwise healthy and young, experienced a favorable prognosis with near-normal recovery following surgical reconstruction.
Given that direct suture without tension was successfully performed in all cases [PMID:22821710], this technique may potentially enhance functional recovery and prognosis for patients suffering from proximal femoral nerve injuries.
References
1 Liu Q, Deng X, Hou Z, Xu L, Zhang Y. Selective Repair of Motor Branches in the Femoral Nerve by Transferring the Motor Branches of Obturator Nerve: An Anatomical Feasibility Study. Annals of plastic surgery 2023. link 2 Miura Y, Fujita K, Nimura A, Miyamoto T, Wakabayashi Y, Okawa A. Successful Reconstruction of a Traumatic Complete Femoral Nerve Rupture with a Sural Nerve Cable Graft: A Case Report. JBJS case connector 2018. link 3 Goubier JN, Teboul F, Yeo S. Transfer of two motor branches of the anterior obturator nerve to the motor portion of the femoral nerve: an anatomical feasibility study. Microsurgery 2012. link