Upper Extremity Ballistic Nerve Injury: A Scoping Review and Algorithm for Management.

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Trauma Surgery

Background:

• Gunshot wounds (GSWs) to the upper extremity (UE) commonly result in peripheral nerve injuries due to the dense neurovascular structures.
• Approximately 25% of UE GSW patients sustain nerve injuries, with over half being neurapraxic.
• Surgical exploration reveals transected or discontinuous nerves in nearly one-third of UE nerve injury cases.

Purpose of the Study:

• To propose a management algorithm for peripheral nerve injuries resulting from gunshot wounds to the upper extremity.
• To clarify indications for surgical intervention and optimize patient outcomes.
• To emphasize the importance of early evaluation and referral for GSW-related nerve injuries.

Main Methods:

• Development of a 4-question management algorithm based on clinical examination, concomitant injuries, operative field proximity, and intraoperative findings.
• Review of existing literature on surgical management of GSW-induced nerve injuries.
• Emphasis on early exploration versus expectant management.

Main Results:

• Nerve reconstruction can yield reasonable results for GSW-related nerve injuries.
• Early exploration may offer improved recovery in specific situations compared to expectant management.
• A structured approach can guide treatment decisions.

Conclusions:

• A proposed algorithm aids in managing UE nerve injuries from GSWs.
• Early surgical exploration and prompt referral to a peripheral nerve specialist are crucial for potentially improving recovery.
• Timely intervention is key for optimizing functional outcomes in GSW nerve injuries.