Clinical and user-friendly classification of traumatic digital nerve injuries of hand

Surgical findings of traumatic neurapraxia and neurotmesis in digital nerve injuries of hand have significantly different prognosis and surgeons managing such injuries must be able to provide the expected incidence of these injuries along with decision on surgical exploration. There is a paucity of data in the literature defining the incidence of traumatic neurapraxia and neurotemesis in lacerated hand injuries with clinical features of digital nerve injury.

We carried out a study in an urban practice to understand this problem on 81 consecutive patients with 82 digital nerve injuries over 1.5 years. Seventy-two percent of the injuries were caused mainly in the domestic accidents by glass and knife. All patients had clinical features of digital nerve injury.

Operative findings revealed nerve damage in 76 patients (confidence interval at 95% = 91-97). Seventy-one had severed nerves and underwent repair (CI at 95% = 80-95). There were 7% patients with operative findings of normal looking nerves and 6% of bruised but intact nerves. All of these 13% patients who did not require surgical repair were grouped as traumatic neurapraxia and showed complete clinical recovery.

Traumatic neurapraxia in digital nerve injuries of the hand are not uncommon, as previously thought, following lacerated injuries to hand and have favourable prognosis. This information is important for clinicians in getting more informed consent and patient education. The classification of digital nerve injuries into traumatic neurapraxia and neurotemesis appears logical for its practical application in routine clinical practice.