Nerve injury in severe trauma with upper extremity involvement: evaluation of 49,382 patients from the TraumaRegister DGU® between 2002 and 2015

Abstract

BackgroundPeripheral nerve injury (PNI) as an adjunct lesion in patients with upper extremity trauma has not been investigated in a Central European setting so far, despite of its devastating long-term consequences. This study evaluates a large multinational trauma registry for prevalence, mechanisms, injury severity and outcome characteristics of upper limb nerve lesions.MethodsAfter formal approval the TraumaRegister DGU® (TR-DGU) was searched for severely injured cases with upper extremity involvement between 2002 and 2015. Patients were separated into two cohorts with regard to presence of an accompanying nerve injury. For all cases demographic data, trauma mechanism, concomitant lesions, severity of injury and outcome characteristics were obtained and group comparisons performed.ResultsAbout 3,3% of all trauma patients with upper limb affection (n = 49,382) revealed additional nerve injuries. PNI cases were more likely of male gender (78,6% vs.73,2%) and tended to be significantly younger than their counterparts without nerve lesions (mean age 40,6 y vs. 47,2 y). Motorcycle accidents were the most frequently encountered single cause of injury in PNI patients (32,5%), whereas control cases primarily sustained their trauma from high or low falls (32,2%). Typical lesions recognized in PNI patients were fractures of the humerus (37,2%) or ulna (20,3%), vascular lacerations (arterial 10,9%; venous 2,4%) and extensive soft tissue damage (21,3%). Despite of similar average trauma severity in both groups patients with nerve affection had a longer primary hospital stay (30,6 d vs. 24,2 d) and required more subsequent inpatient rehabilitation (36,0% vs. 29,2%).ConclusionPNI complicating upper extremity trauma might be more commonly encountered in Central Europe than suggested by previous foreign studies. PNI typically affect males of young age who show significantly increased length of hospitalization and subsequent need for inpatient rehabilitation. Hence these lesions induce extraordinary high financial expenses besides their impact on health related quality of life for the individual patient. Further research is necessary to develop specific prevention strategies for this kind of trauma.

Advances in the repair of segmental nerve injuries and trends in reconstruction

“…The majority of nerve injuries occur in the upper extremity . It is estimated that 1‐3% of all upper extremity trauma patients are diagnosed with nerve injuries during the first few months after trauma . These injuries are often severely debilitating, resulting in lifestyle disruptions from loss of function, both at work and in leisure .…”

Acute and long-term costs of 268 peripheral nerve injuries in the upper extremity

“…While other traumatic injuries as for example polytrauma are generally more expensive [18,19], it is the frequency of hand and upper extremity injuries and the subsequent risk of nerve injury that constitutes its socioeconomic importance, especially in work related accidents. In a recent analysis from the German Trauma Registry (TraumaRegister DGU1), 3.3% of all trauma patients (private and work accidents) with upper limb affection suffered from additional peripheral nerve injury, and in a subset of motor cycle injuries this increased to 32.5% [1]. This study likewise showed that trauma patients with nerve injury compared to equally injured patients without, had significantly longer primary hospital stay of on average six days and required more inpatient rehabilitation [1].…”

“…In a recent analysis from the German Trauma Registry (TraumaRegister DGU1), 3.3% of all trauma patients (private and work accidents) with upper limb affection suffered from additional peripheral nerve injury, and in a subset of motor cycle injuries this increased to 32.5% [1]. This study likewise showed that trauma patients with nerve injury compared to equally injured patients without, had significantly longer primary hospital stay of on average six days and required more inpatient rehabilitation [1]. Both duration of stay and long-term rehabilitation were indicators for higher costs and associated with longer time off work.…”

“…Patients were identified by ICD Code (G56.2, G56.3, S54.0, S44.0, S64.0, G56. 3 [1][2][3][4]. Thereby, all patients with work-related traumatic nerve lesions of the upper extremity between 2012 and 2016 treated at the BG Trauma Center Ludwigshafen were included in the analysis.…”

“…Upper extremities are the most frequently injured body part and its peripheral nerves are easily severed by cutting or other traumatic injuries [1]. Consequently, the hand, our primary tool for environment interaction, is handicapped with potentially long-lasting deficits in a patient population that is generally young and healthy [2,3].…”