Open Access Original research

Treatment of penetrating trauma of the extremities: ten years’ experience at a dutch level 1 trauma center

Oscar JF Van Waes*, Esther MM Van Lieshout, Wouter Hogendoorn, Jens A Halm and Jefrey Vermeulen

Author Affiliations

Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, the Netherlands

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2013, 21:2  doi:10.1186/1757-7241-21-2

Published: 14 January 2013

Abstract

Background

A selective non-operative management (SNOM) has found to be an adequate and safe strategy to assess and treat patients suffering from penetrating trauma of the extremities (PTE). With this SNOM comes a strategy in which adjuvant investigations or interventions are not routinely performed, but based on physical examination only.

Methods

All subsequent patients presented with PTE at a Dutch level I trauma center from October 2000 to June 2011 were included in this study. In-hospital and long-term outcome was analysed in the light of assessment of these patients according to the SNOM protocol.

Results

A total of 668 patients (88.2% male; 33.8% gunshot wounds) with PTE presented at the Emergency Department of a level 1 traumacenter, of whom 156 were admitted for surgical treatment or observation. Overall, 22 (14%) patients that were admitted underwent exploration of the extremity for vascular injury. After conservative observation, two (1.5%) patients needed an intervention to treat (late onset) vascular complications. Other long-term extremity related complications were loss of function or other deformity (n = 9) due to missed nerve injury, including 2 patients with peroneal nerve injury caused by delayed compartment syndrome treatment.

Conclusion

A SNOM protocol for initial assessment and treatment of PTE is feasible and safe. Clinical examination of the injured extremity is a reliable diagnostic 'tool' for excluding vascular injury. Repeated assessments for nerve injuries are important as these are the ones that are frequently missed and result in long-term disability. Level of evidence: II / III, retrospective prognostic observational cohort study Key words Penetrating trauma, extremity, vascular injury, complications.