Abstract
Objective
The purpose of this study was to describe the frequency of nerve injury associated with lower extremity ballistic trauma, the associated skeletal and soft tissue injuries, and the rate of neurologic recovery.
Design and setting
A retrospective review of an institutional trauma database was completed at a single level 1 trauma academic medical center.
Patients
This was an institutional review board approved retrospective cohort study of patients over 16 years of age presenting with ballistic-related traumatic injury to the lower extremities between May 2018 and May 2019. All patients identified with lower extremity ballistic trauma were included in this study. The rate of nerve palsy, associated skeletal injury, and operative fixation were recorded for each anatomic zone. Rates of associated concomitant vascular injury, fracture, and compartment syndrome were collected through a review of the electronic medical records. Chart review was performed to evaluate outcomes and nerve recovery.
Results
Twenty-one patients (21 extremities, 21/148, 14%) were diagnosed by attending physicians, fellowship-trained in orthopedic trauma, as having ballistic-related nerve injuries. Seventy-three percent of patients with a documented neurologic injury (11/15) demonstrated complete nerve recovery as measured by the MRC and sensory scale assessment at most recent follow-up, while the rest demonstrated no improvement in their neurologic deficits from presentation. The rate of associated vascular injury in patients with lower extremity nerve palsies was 38% (8/21). While the rate of vascular injury in the absence of neurologic injury was 3% (4/127).
Conclusions
This series of lower extremity nerve injuries in a large sample of urban lower extremity ballistic trauma noted a high rate of concomitant nerve injuries. An associated diagnosis of a vascular injury appears to portend a higher risk of neurologic injury. Treating surgeons should have a high index of suspicion for associated vascular injury in patients presenting with a ballistic lower extremity nerve palsy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Global Burden of Disease Injury C, Naghavi M, Marczak LB, Kutz M, Shackelford KA, Arora M et al (2018) Global mortality from firearms, 1990–2016. JAMA 320:792–814
Dicpinigaitis PA, Koval KJ, Tejwani NC, Egol KA (2006) Gunshot wounds to the extremities. Bull NYU Hosp Jt Dis 64:139–155
Bartlett CS, Helfet DL, Hausman MR, Strauss E (2000) Ballistics and gunshot wounds: effects on musculoskeletal tissues. J Am Acad Orthop Surg 8:21–36
Geissler WB, Teasedall RD, Tomasin JD, Hughes JL (1990) Management of low velocity gunshot-induced fractures. J Orthop Trauma 4:39–41
Straszewski AJ, Schultz K, Dickherber JL, Dahm JS, Wolf JM, Strelzow JA (2021) Gunshot-related upper extremity nerve injuries at a level 1 trauma center. J Hand Surg Am 47(1):88-e1. https://doi.org/10.1016/j.jhsa.2021.03.020
Compston A (2010) Aids to the investigation of peripheral nerve injuries. medical research council: nerve injuries research committee. his majesty’s stationery office: 1942; pp. 48 (iii) and 74 figures and 7 diagrams; with aids to the examination of the peripheral nervous system. by Michael O’brien for the guarantors of brain. Saunders Elsevier: 2010; pp. [8] 64 and 94 figures. Brain 133:2838–2844
Berg RJ, Okoye O, Inaba K, Konstantinidis A, Branco B, Meisel E et al (2012) Extremity firearm trauma: the impact of injury pattern on clinical outcomes. Am Surg 78:1383–1387
Kouyoumdjian JA (2006) Peripheral nerve injuries: a retrospective survey of 456 cases. Muscle Nerve 34:785–788
Kouyoumdjian JA, Graca CR, Ferreira VFM (2017) Peripheral nerve injuries: a retrospective survey of 1124 cases. Neurol India 65:551–555
Mehta SK, Dale WW, Dedwylder MD, Bergin PF, Spitler CA (2018) Rates of neurovascular injury, compartment syndrome, and early infection in operatively treated civilian ballistic forearm fractures. Injury 49:2244–2247
Abghari M, Monroy A, Schubl S, Davidovitch R, Egol K (2015) Outcomes following low-energy civilian gunshot wound trauma to the lower extremities: results of a standard protocol at an urban trauma center. Iowa Orthop J 35:65–69
Daneyemez M, Solmaz I, Izci Y (2005) Prognostic factors for the surgical management of peripheral nerve lesions. Tohoku J Exp Med 205:269–275
Pannell WC, Heckmann N, Alluri RK, Sivasundaram L, Stevanovic M, Ghiassi A (2017) Predictors of nerve injury after gunshot wounds to the upper extremity. Hand (N Y) 12:501–506
Omer GE Jr (1974) Injuries to nerves of the upper extremity. J Bone Joint Surg Am 56:1615–1624
Bergquist ER, Hammert WC (2013) Timing and appropriate use of electrodiagnostic studies. Hand Clin 29:363–370
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Baker, H.P., Straszewski, A.J., Dahm, J.S. et al. Gunshot-related lower extremity nerve injuries. Eur J Orthop Surg Traumatol 33, 851–856 (2023). https://doi.org/10.1007/s00590-022-03220-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-022-03220-3