Nerve Injury Related to Firearm Extremity Trauma

Introduction: Firearm-related extremity trauma with nerve injury can lead to life-altering impairment and disability. This study evaluated the frequency of nerve injury in firearm-related extremity injuries at a Level 1 trauma centre, and the rate of nerve transection in firearm-related peripheral nerve injuries (PNIs) and brachial plexus injuries (BPIs). Methods: Following Ethics Board approval, institutional trauma and emergency databases (from 2000 to 2020) were used to identify adults with firearm-related PNI or BPI treated at a Level 1 trauma center. Each case of nerve injury was verified by chart review and excluded isolated digital nerve and other cutaneous nerve injuries. Medical charts were reviewed to retrieve patient and injury data. Results: In total, 1957 patients were identified with firearm injuries; the nerve injury study sample included 86 patients (95% males) and 98 nerves injured. The most common upper extremity nerve injured was the radial and/or posterior interosseous nerve (n = 30, 25%) and in the lower extremity, the sciatic nerve (n = 15, 13%). Nerve transection was confirmed in 21% of cases by surgical exploration (n = 19) or ultrasound imaging (n = 2). Axonotmetic injuries were confirmed in 20% of cases and in total only 41% of patients had full spontaneous functional recovery. Compared to neurapraxia, neurotmesis injuries had a significantly increased likelihood of concomitant vascular injury (P = .007) but not skeletal injuries (P = .65). Injury severity score was not associated with nerve injury severity (P = .27). Conclusion: Nerve transections due to firearm-related trauma occur more frequently than previously believed. Early identification and surgical management of nerve transection injuries is imperative.