Predictors of Nerve Injury After Gunshot Wounds to the Upper Extremity

The purpose of this study is to examine the incidence of nerve injury, clinical variables associated with nerve palsy, and predictive factors of nerve laceration after gunshot wounds to the upper extremity.

Forty-one patients from a level I trauma center with gunshot wounds to the upper extremity who underwent surgical exploration between 2007 and 2014 were identified retrospectively. Patients with proximal ipsilateral injuries, inadequate documentation, imaging, or with a pre-existing neurologic deficit were excluded. Patient demographics, clinical sensory and motor examination, the presence of retained bullet fragments, fracture, vascular injury, and compartment syndrome were recorded. Univariate analysis was performed to determine significant predictors of intraoperative nerve laceration. Significance was set at P < .05.

Fifty-nine nerves were explored in 41 patients. There were higher frequencies of fractures, retained fragments, vascular injury, and compartment syndrome in patients with nerve palsies, although none were associated with nerve laceration. Patients with palsies on presentation were significantly more likely to have a nerve laceration found intraoperatively.

Gunshot wounds to the upper extremity with focal nerve deficits remain a difficult problem for orthopedic surgeons. The present study provides evidence that may help guide operative decision making in treatment of these injuries.