Results of untreated peripheral nerve injuries

Closed injuries involving peripheral nerves are likely to occur in a severely comminuted fracture, a dislocated or stretched joint, or a fracture adjacent to a joint. Peripheral neuropathy associated with fractures are usually neurapraxia lesions and have an excellent prognosis for spontaneous recovery. Peripheral neuropathy associated with open injuries has a prognosis related to the etiology; lacerations are usually neurotmesis lesions and should be completely examined, explored, and sutured; shotgun wounds demand debridement and visualization of involved peripheral nerves; high-velocity missile wounds often create axonotmesis lesions, and involved peripheral nerves have a better prognosis for spontaneous recovery than peripheral neuropathy associated with low-velocity missile wounds. Complete and precise physical examination of peripheral nerve function at the time of injury is the best baseline for management. Electrodiagnostic studies should be initiated after one month and recorded periodically to evaluate the course of clinical recovery. It is appropriate to explore at three to four months the total nerve lesion associated with missile and shotgun wounds above the elbow or knee, stretch injuries from dislocated joints, and fractures that are severely comminuted or adjacent to joints. Many of these nerves will have a neuroma-in-continuity, and precise techniques for evaluation of nerve conduction must be utilized.