Clinical characteristics and management of gunshot wound injuries to the peripheral nerves

Peripheral nerve injuries (PNI) secondary to gunshot wounds (GSW) are a unique category of neurologic injury that can cause morbidity in young, otherwise healthy individuals, occurring in 25-36% of GSWs. The management of these injuries is understudied and varies throughout the literature. To characterize the clinical characteristics, management, and outcomes of peripheral nerve injury secondary to GSWs through a retrospective review of a single urban Level 1 trauma center's experience. Charts were reviewed from 2009 to 2021 for demographics, clinical characteristics, injury patterns, and treatment. Statistical analysis included chi-square testing for dichotomized variables with resultant odds ratios and measures of central tendency for all variables. All statistics were performed using GraphPad Prism 9 software (Boston, MA). 49 patients were included for analysis. The average age was 28.6 years old, 83.7% of patients were male, 79.6% were Black, and 74.1% were insured by Medicaid. 79.9% of patients had motor deficits, 73.5% had sensory deficits, and 61.2% had a combination. These deficits were not predictive of the need for peripheral nerve surgery (PNS) (p = 0.99). Median nerve injury was most predictive of requiring surgery with 67% requiring surgery compared to 10.6% of patients with other nerve injuries (67% versus 10.7, p < 0.014). Patients were more like to receive antibiotics if they had retained bullet fragments present (p < 0.001). Cefazolin was the most commonly administered antibiotic (65.31%). If PNS was indicated, it occurred on average 161.63 days post-injury. 46.93% had chronic pain, though there was no statistical difference in the development of chronic pain between upper versus lower extremity injuries (p = 0.99). PNIs secondary to GSW are heterogenous injuries due to the variability in the mechanism of injury, associated deficits, interventions required, and potential for recovery.