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Nerve Injury Related to Firearm Extremity Trauma.

Emma Avery1, Harry Lau2, Stephanie Stefaniuk3

  • 1Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.

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|November 24, 2025
PubMed
Summary
This summary is machine-generated.

Firearm extremity trauma frequently causes nerve injuries, with 21% of cases involving nerve transections. Early surgical intervention is crucial for managing these severe peripheral nerve injuries (PNIs) and brachial plexus injuries (BPIs).

Keywords:
evaluationfirearm traumanerve injurynerve transectionretrospective review

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Area of Science:

  • Orthopedic Surgery
  • Neurosurgery
  • Trauma Surgery

Background:

  • Firearm-related extremity trauma can cause significant nerve injury, leading to long-term disability.
  • Peripheral nerve injuries (PNIs) and brachial plexus injuries (BPIs) from firearms require thorough evaluation.
  • Understanding the incidence and characteristics of these injuries is vital for effective treatment.

Purpose of the Study:

  • To determine the frequency of nerve injury in firearm-related extremity trauma.
  • To assess the rate of nerve transection in firearm-related PNIs and BPIs.
  • To analyze factors associated with nerve injury severity and recovery.

Main Methods:

  • Retrospective review of adult patients with firearm-related PNIs or BPIs treated at a Level 1 trauma center (2000-2020).
  • Data extracted from institutional trauma and emergency databases, with chart review for verification.
  • Exclusion of isolated digital nerve and cutaneous nerve injuries.

Main Results:

  • 86 patients with 98 nerve injuries were identified; 95% were male.
  • Most common upper extremity nerve injury: radial/posterior interosseous (25%). Lower extremity: sciatic nerve (13%).
  • Nerve transection confirmed in 21% of cases; 20% had axonotmetic injuries. Only 41% achieved full spontaneous recovery.

Conclusions:

  • Nerve transections are more common in firearm-related extremity trauma than previously recognized.
  • Early identification and surgical management of transected nerves are imperative for optimal outcomes.
  • Neurotmesis injuries showed increased likelihood of vascular injury compared to neurapraxia.